Long-term beneficial effect of islet transplantation on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients

Paolo Fiorina, Franco Folli, Federico Bertuzzi, Paola Maffi, Giovanna Finzi, Massimo Venturini, Carlo Socci, Alberto Davalli, Elena Orsenigo, Lucilla Monti, Luca Falqui, Silvia Uccella, Stefano La Rosa, Luciana Usellini, Giuliana Properzi, Valerio Di Carlo, Alessandro Del Maschio, Carlo Capella, Antonio Secchi

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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: A 1-3 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.

Original languageEnglish (US)
Pages (from-to)1129-1136
Number of pages8
JournalDiabetes care
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2003

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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    Fiorina, P., Folli, F., Bertuzzi, F., Maffi, P., Finzi, G., Venturini, M., Socci, C., Davalli, A., Orsenigo, E., Monti, L., Falqui, L., Uccella, S., La Rosa, S., Usellini, L., Properzi, G., Di Carlo, V., Del Maschio, A., Capella, C., & Secchi, A. (2003). Long-term beneficial effect of islet transplantation on diabetic macro-/microangiopathy in type 1 diabetic kidney-transplanted patients. Diabetes care, 26(4), 1129-1136. https://doi.org/10.2337/diacare.26.4.1129