Islet transplantation is associated with improvement of renal function among uremic patients with type I diabetes mellitus and kidney transplants

Paolo Fiorina, Franco Folli, Gianpaolo Zerbini, Paola Maffi, Chiara Gremizzi, Valerio Di Carlo, Carlo Socci, Federico Bertuzzi, Michael Kashgarian, Antonio Secchi

Research output: Contribution to journalArticle

124 Scopus citations

Abstract

The potential effects of islet transplantation on the renal function of 36 patients with type I diabetes mellitus and kidney transplants were studied with 4 yr of follow-up monitoring. Kidney-islet recipients were divided into two groups, i.e., patients with successful islet transplants (SI-K group) (n = 24, fasting C-peptide levels of >0.5 ng/ml for >1 yr) and patients with unsuccessful islet transplants (UI-K group) (n = 12, fasting C-peptide levels of <0.5 ng/ml). Kidney graft survival rates and function, urinary albumin excretion rates, and sodium handling were compared. Na+/K+-ATPase activity in protocol kidney biopsies and in red blood cells was cross-sectionally analyzed. The SI-K group demonstrated better kidney graft survival rates (100, 83, and 83% at 1, 4, and 7 yr, respectively) than did the UI-K group (83, 72, and 51% at 1, 4, and 7 yr, respectively; P = 0.02). The SI-K group demonstrated reductions in exogenous insulin requirements and higher C-peptide levels, compared with the UI-K group, whereas GFR values were similar. Microalbuminuria (urinary albumin index) increased significantly in the UI-K group only (UI-K, from 92.0 ± 64.9 to 183.8 ± 83.8, P = 0.05; SI-K, from 108.5 ± 53.6 to 85.0 ± 39.0, NS). In the SI-K group, but not in the UI-K group, natriuresis decreased at 2 and 4 yr (P < 0.01). The SI-K group demonstrated greater Na+/K+-ATPase immunoreactivity in renal tubular cells (P = 0.05) and higher activity in red blood cells (P = 0.03), compared with the UI-K group. The Na+/K+-ATPase activity in red blood cells was positively correlated with circulating C-peptide levels but not with glycated hemoglobin levels. Successful islet transplantation was associated with improvements in kidney graft survival rates and function among uremic patients with type I diabetes mellitus and kidney grafts.

Original languageEnglish (US)
Pages (from-to)2150-2158
Number of pages9
JournalJournal of the American Society of Nephrology
Volume14
Issue number8
DOIs
StatePublished - Aug 1 2003

    Fingerprint

ASJC Scopus subject areas

  • Nephrology

Cite this

Fiorina, P., Folli, F., Zerbini, G., Maffi, P., Gremizzi, C., Di Carlo, V., Socci, C., Bertuzzi, F., Kashgarian, M., & Secchi, A. (2003). Islet transplantation is associated with improvement of renal function among uremic patients with type I diabetes mellitus and kidney transplants. Journal of the American Society of Nephrology, 14(8), 2150-2158. https://doi.org/10.1097/01.ASN.0000077339.20759.A3