Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety.

Autor:	Boggi U; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.; Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy., Baronti W; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Amorese G; Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy., Pilotti S; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy., Occhipinti M; Diabetes Unit, Versilia Hospital, Azienda ASL Area Vasta Nord-Ovest, Lido di Camaiore, Lucca, Italy., Perrone V; Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy., Marselli L; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.; Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy., Barsotti M; Division of Nephrology, Cisanello University Hospital, Pisa, Italy., Campani D; Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy., Gianetti E; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Insilla AC; Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy., Bosi E; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Kaufmann E; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy., Terrenzio C; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., Vistoli F; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.; Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy., Marchetti P; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.; Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2022 Jan 01; Vol. 106 (1), pp. 147-157.
DOI:	10.1097/TP.0000000000003627
Abstrakt:	Background: Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. Methods: This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. Results: Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. Conclusions: These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients. Competing Interests: The authors declare no funding or conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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