In patients with type 1 diabetes simultaneous pancreas and kidney transplantation preserves long-term kidney graft ultrastructure and function better than transplantation of kidney alone
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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.
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).
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).
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.
KeywordsDiabetic nephropathy Glomerular basement membrane Glomerular filtration rate Glomerular mesangium Kidney transplantation Pancreatic transplantation Type 1 diabetes
Angiotensin receptor blocker
Chronic allograft damage index
Diabetes Control and Complications Trial
Estimated glomerular filtration rate
End-stage renal disease
Glomerular basement membrane
Kidney transplantation alone
Live donor kidney
Maximal profile area
Pancreas after kidney
Simultaneous pancreas and kidney
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
JPL, FPR, AH and TJ designed the study, analysed and interpreted the data and wrote the manuscript. IAE, KM, HH, LTD, TMR, SOK, RH, OØ and KB participated in the design of the study, interpreted the data and edited the manuscript. All authors read, commented on and approved the final version of the manuscript to be published. JPL, AH and TJ are responsible for the integrity of the work as a whole.
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