Effects of Kidney-Pancreas Transplantation on Atherosclerotic Risk Factors and Endothelial Function in Patients With Uremia and Type 1 Diabetes

  1. Paolo Fiorina1,
  2. Ennio La Rocca1,
  3. Massimo Venturini2,
  4. Fabio Minicucci3,
  5. Isabella Fermo4,
  6. Rita Paroni4,
  7. Armando D’Angelo4,
  8. Marisa Sblendido3,
  9. Valerio Di Carlo5,
  10. Marco Cristallo5,
  11. Alessandro Del Maschio2,
  12. Guido Pozza1 and
  13. Antonio Secchi1
  1. 1Internal Medicine
  2. 2Radiology
  3. 3Neurophysiology
  4. 4Laboratory Medicine, and
  5. 5General Surgery, San Raffaele Scientific Institute, Universitâ Vita e Salute, Milan, Italy

    Abstract

    Cardiovascular disease and the development of coronary artery disease play a pivotal role in increasing mortality in patients with type 1 diabetes. The aim of our study was to evaluate the effects of pancreas transplantation on atherosclerotic risk factors, endothelial-dependent dilation (EDD), and progression of intima media thickness (IMT) in patients with uremia and type 1 diabetes after kidney-alone (KA) or kidney-pancreas (KP) transplantation. A cross-sectional study comparing two groups of patients with type 1 diabetes was performed. Sixty patients underwent KP transplantation and 30 patients underwent KA transplantation. Age and cardiovascular risk profile were comparable in patients before transplantation. In all patients, atherosclerotic risks factors (lipid profile, fasting and postmethionine load plasma homocysteine, von Willebrand factor levels, d-dimer fragments, and fibrinogen) were assessed and Doppler echographic evaluation of IMT and endothelial function with flow-mediated and nitrate dilation of the brachial artery was performed. Twenty healthy subjects were chosen as controls (C) for EDD. Compared with patients undergoing KA transplantation, patients undergoing KP transplantation showed lower values for HbA1c (KP = 6.2 ± 0.1% vs. KA = 8.4 ± 0.5%; P < 0.01), fasting homocysteine (KP = 14.0 ± 0.7 μmol/l vs. KA = 19.0 ± 2.0 μmol/l; P = 0.02), von Willebrand factor levels (KP = 157.9 ± 8.6% vs. KA = 212.5 ± 16.2%; P < 0.01), d-dimer fragments (KP = 0.29 ± 0.02 μg/ml vs. KA = 0.73 ± 0.11 μg/ml; P < 0.01), fibrinogen (KP = 363.0 ± 11.1 mg/dl vs. KA = 397.6 ± 19.4 mg/dl; NS), triglycerides (KP = 122.7 ± 8.6 mg/dl vs. KA = 187.0 ± 30.1 mg/dl; P = 0.01), and urinary albumin excretion rate (KP = 13.5 ± 1.9 mg/24 h vs. KA = 57.3 ± 26.3 mg/24 h; P < 0.01). Patients undergoing KP transplantation showed a normal EDD (KP = 6.21 ± 2.42%, KA = 0.65 ± 2.74%, C = 8.1 ± 2.1%; P < 0.01), whereas no differences were observed in nitrate-dependent dilation. Moreover, IMT was lower in patients undergoing KP transplantation than in patients undergoing KA transplantation (KP = 0.74 ± 0.03 mm vs. KA = 0.86 ± 0.09 mm; P = 0.04). Our study showed that patients with type 1 diabetes have a lower atherosclerotic risk profile after KP transplantation than after KA transplantation. These differences are tightly correlated with metabolic control, fasting homocysteine levels, lower d-dimer fragments, and lower von Willebrand factor levels. Normal endothelial function and reduction of IMT was observed only in patients undergoing KP transplantation.

    Footnotes

    • Address correspondence and reprint requests to Antonio Secchi, MD, Medicina I, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy. E-mail: antonio.secchi{at}hsr.it.

      Received for publication 24 July 2000 and accepted in revised form 31 October 2000.

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