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Long-Term (5 Years) Efficacy and Safety of Pancreas Transplantation Alone in Type 1 Diabetic Patients

Boggi, Ugo1,6; Vistoli, Fabio1; Amorese, Gabriella1; Giannarelli, Rosa2; Coppelli, Alberto2; Mariotti, Rita3; Rondinini, Lorenzo3; Barsotti, Massimiliamo1; Signori, Stefano1; De Lio, Nelide1; Occhipinti, Margherita2; Mangione, Emanuela2; Cantarovich, Diego1; Del Prato, Stefano2; Mosca, Franco4; Marchetti, Piero2,5

doi: 10.1097/TP.0b013e318247a782
Clinical and Translational Research

Background. Although combined pancreas and kidney transplantation is an established procedure for the treatment of type 1 diabetes (T1D) in patients with end-stage renal disease, the role of pancreas transplant alone (PTA) in the therapy of T1D subjects with preserved kidney function is still matter of debate.

Methods. We report our single-center experience of PTA in 71 consecutive T1D patients all with a posttransplant follow-up of 5 years. Patient and pancreas (normoglycemia in the absence of any antidiabetic therapy) survivals were determined, and several clinical parameters (including risk factors for cardiovascular diseases) were assessed. Cardiac evaluation and Doppler echocardiographic examination were also performed, and renal function and proteinuria were evaluated.

Results. Actual patient and pancreas survivals at 5 years were 98.6% and 73.2%, respectively. Relaparotomy was needed in 18.3% of cases. Restoration of endogenous insulin secretion was accompanied by sustained normalization of fasting plasma glucose concentrations and HbA1c levels as well as significant improvement of total cholesterol, low-density lipoprotein-cholesterol, and blood pressure. An improvement of left ventricular ejection fraction was also observed. Proteinuria (24 hours) decreased significantly after transplantation. One patient developed end-stage renal disease. In the 51 patients with sustained pancreas graft function, kidney function (serum creatinine and glomerular filtration rate) decreased over time with a slower decline in recipients with pretransplant glomerular filtration rate less than 90 mL/min.

Conclusions. PTA was an effective and reasonably safe procedure in this single-center cohort of T1D patients.

1Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.

2Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.

3Division of Cardiology, Cardiac and Thoracic Department, University of Pisa, Pisa, Italy.

4Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.

5Unit of Endocrinology and Metabolism of Transplantation, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.

The authors declare no funding or conflicts of interest.

Address correspondence to: Ugo Boggi, M.D., Division of General and Transplant Surgery in Uremic and Diabetic Patients, Azienda Ospedaliera Universitaria Pisana, Cisanello Hospital, via Paradisa 2, 56124 Pisa, Italy. E-mail: u.boggi@med.unipi.it

U.B. and P.M. participated in research design, performance of the study, and writing the manuscript; F.V., G.A., R.G., A.C., R.M., L.R., M.B., S.S., N.D.L., M.O., E.M., D.C., S.D.P. and F.M. participated in the performance of the research.

Received 14 July 2011. Revision requested 9 August 2011.

Accepted 20 December 2011.

© 2012 Lippincott Williams & Wilkins, Inc.