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Hau, HM; Jahn, N; Brunotte, M; Lederer, AA; Sucher, E; Rasche, FM; Seehofer, D; Sucher, R.
Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft.
BMC Endocr Disord. 2020; 20(1):30 Doi: 10.1186/s12902-020-0506-9 [OPEN ACCESS]
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Leading authors Med Uni Graz: Hau Hans-Michael; Jahn Nora
Co-authors Med Uni Graz: Sucher Robert
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Abstract:: BACKGROUND: In contrast to insulin-dependent type 1 diabetes mellitus (T1DM), the indication for Simultaneous pancreas-kidney transplantation (SPK) in patients with type 2 diabetes mellitus (T2DM) is still ambiguous and wisely Eurotransplant (ET) only granted transplant-permission in a selected group of patients. However, with regard to improvement of metabolic conditions SPK might still be a considerable treatment option for lean insulin dependent type 2 diabetics suffering from renal disease. METHODS: Medical data (2001-2013) from all consecutive T1DM and T2DM patients who received a SPK or kidney transplant alone (KTA) at the University Hospital of Leipzig were analyzed. Donor, recipients and long-term endocrine, metabolic and graft outcomes were investigated for T1DM and T2DM-SPK recipients (transplanted upon a special request allocation by ET) and T2DM patients who received a KTA during the same period. RESULTS: Eighty nine T1DM and 12 T2DM patients received a SPK and 26 T2DM patients received a KTA. Patient survival at 1 and 5 years was 89.9 and 88.8% for the T1DM group, 91.7 and 83.3% for the T2DM group, and 92.3 and 69.2% for the T2DM KTA group, respectively (p < 0.01). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was 83.1 and 78.7% for the T1DM group and 91.7 and 83.3% for the T2DM group, respectively (p = 0.71). Kidney allograft survival at 5 years was 79.8% for T1DM, 83.3% for T2DM, and 65.4% for T2DM KTA (p < 0.01). Delayed graft function (DGF) rate was significantly higher in type 2 diabetics received a KTA. Surgical, immunological and infectious complications showed similar results for T1DM and T2DM recipients after SPK transplant and KTA, respectively. With regard to the lipid profile, the mean high-density lipoprotein (HDL)- cholesterol levels were significantly higher in T1DM recipients compared to T2DM patients before transplantation (p = 0.02) and remained significantly during follow up period. CONCLUSION: Our data demonstrate that with regard to metabolic function a selected group of patients with T2DM benefit from SPK transplantation. Consensus guidelines and further studies for SPK transplant indications in T2DM patients are still warranted.
Find related publications in this database (using NLM MeSH Indexing): Adolescent - administration & dosage; Adult - administration & dosage; Allografts - administration & dosage; Biomarkers - metabolism; Blood Glucose - analysis; Diabetes Mellitus, Type 1 - surgery; Diabetes Mellitus, Type 2 - surgery; Diabetic Nephropathies - epidemiology; Female - administration & dosage; Follow-Up Studies - administration & dosage; Germany - epidemiology; Glycated Hemoglobin - analysis; Humans - administration & dosage; Incidence - administration & dosage; Kidney Transplantation - mortality; Male - administration & dosage; Middle Aged - administration & dosage; Pancreas Transplantation - mortality; Postoperative Complications - epidemiology; Prognosis - administration & dosage; Survival Rate - administration & dosage; Time Factors - administration & dosage; Young Adult - administration & dosage
Find related publications in this database (Keywords): Pancreas transplantation; Type II diabetes; Endocrine and metabolic long-term results; Immunosuppression