Long-Term Beneficial Effect of Islet Transplantation on Diabetic Macro-/Microangiopathy in Type 1 Diabetic Kidney-Transplanted Patients
- Paolo Fiorina, MD1,
- Franco Folli, MD1,
- Federico Bertuzzi, MD1,
- Paola Maffi, MD1,
- Giovanna Finzi, MB2,
- Massimo Venturini, MD3,
- Carlo Socci, MD4,
- Alberto Davalli, MD1,
- Elena Orsenigo, MD4,
- Lucilla Monti, MD1,
- Luca Falqui, MD1,
- Silvia Uccella, MD2,
- Stefano La Rosa, MD2,
- Luciana Usellini, MB2,
- Giuliana Properzi, MD5,
- Valerio Di Carlo, MD46,
- Alessandro Del Maschio, MD36,
- Carlo Capella, MD2 and
- Antonio Secchi, MD16
- 1Department of Internal Medicine I, San Raffaele Scientific Institute, Milan, Italy
- 2Department of Pathology, Insubria University, Varese, Italy
- 3Department of Radiology, San Raffaele Scientific Institute, Milan, Italy
- 4Department of General Surgery, San Raffaele Scientific Institute, Milan, Italy
- 5Department of Medicine, L’Aquila University, L’Aquila, Italy
- 6Vita e Salute-San Raffaele University, Milan, Italy
Abstract
OBJECTIVE—Our aim was to evaluate the long-term effects of transplanted islets on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients.
RESEARCH DESIGN AND METHODS—A total of 34 type 1 diabetic kidney-transplanted patients underwent islet transplantation and were divided into two groups: successful islet-kidney transplantation (SI-K; 21 patients, fasting C-peptide serum concentration >0.5 ng/ml for >1 year) and unsuccessful islet-kidney transplantation (UI-K; 13 patients, fasting C-peptide serum concentration <0.5 ng/ml). Patients cumulative survival, cardiovascular death rate, and atherosclerosis progression were compared in the two groups. Skin biopsies, endothelial dependent dilation (EDD), nitric oxide (NO) levels, and atherothrombotic risk factors [von Willebrand factor (vWF) and d-dimer fragment (DDF)] were studied cross-sectionally.
RESULTS—The SI-K group showed a significant better patient survival rate (SI-K 100, 100, and 90% vs. UI-K 84, 74, and 51% at 1, 4, and 7 years, respectively, P = 0.04), lower cardiovascular death rate (SI-K 1/21 vs. UI-K 4/13, χ2 = 3.9, P = 0.04), and lower intima-media thickness progression than the UI-K group (SI-K group: Δ1–3 years −13 ± 30 μm vs. UI-K group: Δ1–3 years 245 ± 20 μm, P = 0.03) with decreased signs of endothelial injuring at skin biopsy. Furthermore, the SI-K group showed a higher EDD than the UI-K group (EDD: SI-K 7.8 ± 4.5% vs. UI-K 0.5 ± 2.7%, P = 0.02), higher basal NO (SI-K 42.9 ± 6.5 vs. UI-K 20.2 ± 6.8 μmol/l, P = 0.02), and lower levels of vWF (SI-K 138.6 ± 15.3 vs. UI-K 180.6 ± 7.0%, P = 0.02) and DDF (SI-K 0.61 ± 0.22 vs. UI-K 3.07 ± 0.68 μg/ml, P < 0.01). C-peptide-to-creatinine ratio correlated positively with EDD and NO and negatively with vWF and DDF.
CONCLUSIONS—Successful islet transplantation improves survival, cardiovascular, and endothelial function in type 1 diabetic kidney-transplanted patients.
- DBP, diastolic blood pressure
- DDF, d-dimer fragment
- ecNOs, endothelial constitutive nitric oxide synthase
- EDD, endothelial dependent dilation
- IMT, intima-media thickness
- SBP, systolic blood pressure
- SI-K, successful islet-kidney transplantation
- UI-K, unsuccessful islet-kidney transplantation
- vWF, von Willebrand factor
Footnotes
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Address correspondence and reprint requests to Antonio Secchi, MD, Vita e Salute-San Raffaele University, Via Olgettina 60, 20132, Milano, Italy. E-mail: antonio.secchi{at}hsr.it.
Received for publication 24 October 2002 and accepted for publication 7 January 2003.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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