AIMS/HYPOTHESIS: In patients with type 1 diabetes and end-stage renal disease (ESRD) we aimed to determine whether long-term normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, would preserve kidney graft structure and function better than live donor kidney (LDK) transplantation alone. METHODS: Estimated GFR (eGFR) was calculated in SPK (n = 25) and LDK (n = 17) recipients in a stable phase 3 months after transplantation and annually during follow-up. Kidney graft biopsies were obtained at follow-up for measurement of glomerular volume (light microscopy), glomerular basement membrane (GBM) and podocyte foot process widths and mesangial volume fraction (electron microscopy). RESULTS: SPK and LDK recipients were similar in age and diabetes duration at engraftment. Donor age was higher in the LDK group. Median follow-up time was 10.1 years. Mean HbA1c levels during follow-up were 5.5 ± 0.4% (37 ± 5 mmol/mol) and 8.3 ± 1.5% (68 ± 16 mmol/mol) in the SPK and LDK group, respectively (p < 0.001). Compared with SPK recipients, LDK recipients had wider GBM (369 ± 109 nm vs 281 ± 57 nm; p = 0.008) and increased mesangial volume fraction (median 0.23 [range 0.13-0.59] vs 0.16 [0.10-0.41]; p = 0.007) at follow-up. Absolute eGFR change from baseline was -11 ± 21 and -23 ± 15 ml min(-1) 1.73 m(-2) (p = 0.060), whereas eGFR slope was -1.1 (95% CI -1.7, -0.5) and -2.6 (95% CI -3.1, -2.1) ml min(-1) 1.73 m(-2) per year in the SPK and LDK group, respectively (p = 0.001). CONCLUSIONS/ INTERPRETATION: In patients with type 1 diabetes and long-term normoglycaemia after successful SPK transplantation, kidney graft ultrastructure and function were better preserved compared with LDK transplantation alone.
AIMS/HYPOTHESIS: In patients with type 1 diabetes and end-stage renal disease (ESRD) we aimed to determine whether long-term normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, would preserve kidney graft structure and function better than live donor kidney (LDK) transplantation alone. METHODS: Estimated GFR (eGFR) was calculated in SPK (n = 25) and LDK (n = 17) recipients in a stable phase 3 months after transplantation and annually during follow-up. Kidney graft biopsies were obtained at follow-up for measurement of glomerular volume (light microscopy), glomerular basement membrane (GBM) and podocyte foot process widths and mesangial volume fraction (electron microscopy). RESULTS: SPK and LDK recipients were similar in age and diabetes duration at engraftment. Donor age was higher in the LDK group. Median follow-up time was 10.1 years. Mean HbA1c levels during follow-up were 5.5 ± 0.4% (37 ± 5 mmol/mol) and 8.3 ± 1.5% (68 ± 16 mmol/mol) in the SPK and LDK group, respectively (p < 0.001). Compared with SPK recipients, LDK recipients had wider GBM (369 ± 109 nm vs 281 ± 57 nm; p = 0.008) and increased mesangial volume fraction (median 0.23 [range 0.13-0.59] vs 0.16 [0.10-0.41]; p = 0.007) at follow-up. Absolute eGFR change from baseline was -11 ± 21 and -23 ± 15 ml min(-1) 1.73 m(-2) (p = 0.060), whereas eGFR slope was -1.1 (95% CI -1.7, -0.5) and -2.6 (95% CI -3.1, -2.1) ml min(-1) 1.73 m(-2) per year in the SPK and LDK group, respectively (p = 0.001). CONCLUSIONS/ INTERPRETATION: In patients with type 1 diabetes and long-term normoglycaemia after successful SPK transplantation, kidney graft ultrastructure and function were better preserved compared with LDK transplantation alone.
Authors: M Luiza Caramori; Youngki Kim; Chunmei Huang; Alfred J Fish; Stephen S Rich; Michael E Miller; Greg Russell; Michael Mauer Journal: Diabetes Date: 2002-02 Impact factor: 9.461
Authors: J P Lindahl; A Hartmann; R Horneland; H Holdaas; A V Reisæter; K Midtvedt; T Leivestad; O Oyen; T Jenssen Journal: Diabetologia Date: 2013-04-03 Impact factor: 10.122
Authors: Brian J Nankivell; Richard J Borrows; Caroline L-S Fung; Philip J O'Connell; Richard D M Allen; Jeremy R Chapman Journal: N Engl J Med Date: 2003-12-11 Impact factor: 91.245
Authors: Brian Y Young; Jagbir Gill; Edmund Huang; Steven K Takemoto; Bishoy Anastasi; Tariq Shah; Suphamai Bunnapradist Journal: Clin J Am Soc Nephrol Date: 2009-02-06 Impact factor: 8.237
Authors: Hans W Sollinger; Jon S Odorico; Yolanda T Becker; Anthony M D'Alessandro; John D Pirsch Journal: Ann Surg Date: 2009-10 Impact factor: 12.969
Authors: M J Mihatsch; T Antonovych; S O Bohman; R Habib; U Helmchen; L H Noel; S Olsen; R K Sibley; E Kemény; G Feutren Journal: Clin Nephrol Date: 1994-01 Impact factor: 0.975
Authors: Aleksandra Kukla; Pedro Ventura-Aguiar; Matthew Cooper; Eelco J P de Koning; David J Goodman; Paul R Johnson; Duck J Han; Didier A Mandelbrot; Martha Pavlakis; Frantisek Saudek; Marie-Christine Vantyghem; Titus Augustine; Michael R Rickels Journal: Am J Kidney Dis Date: 2021-05-14 Impact factor: 11.072
Authors: Phuoc H Pham; Lily N Stalter; Eric J Martinez; Jesse F Wang; Bridget M Welch; Glen Leverson; Nicholas Marka; Talal Al-Qaoud; Didier Mandelbrot; Sandesh Parajuli; Hans W Sollinger; Dixon Kaufman; Robert R Redfield; Jon S Odorico Journal: Am J Transplant Date: 2021-01-15 Impact factor: 9.369