Diabetologia

, Volume 34, Supplement 1, pp S141–S144 | Cite as

Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic Type 1 (insulin-dependent) diabetic patients

  • A. Secchi
  • V. Di Carlo
  • S. Martinenghi
  • E. La Rocca
  • R. Caldara
  • D. Spotti
  • G. Slaviero
  • C. Staudacher
  • G. Ferrari
  • G. Pozza
Quality of Life

Summary

The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1(insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) than in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts). Evaluation of quality of life in patients receiving a kidney and pancreas transplantation showed an improvement in psychological well-being, when compared to patients receiving a kidney transplantation alone. Physical well-being was similar in patients transplanted with kidney and pancreas or with kidney alone.

Key Words

Kidney transplantation Pancreas transplantation Life expectancy Quality of life 

References

  1. Bandello F, Vigano C, Secchi A, La Rocca E, Spotti D, Caldara R, Staudacher C, Carlucci M, Castoldi R, Di Carlo V, Brancato R and Pozza G. (1989) Diabetic retinopathy in patients submitted to successful kidney-pancreas allotransplantation. Diabetes 38, suppl 1Google Scholar
  2. Biluos RW, Mauer SM, Sutherland DER, Najarian JS, Goetz FC, Steffes MW (1989) The effects of pancreas transplantation on the glomerular structure of renol allografts in patients with insulin-dependent diabetes. New Engl. J Med. 321, No 2:80–85Google Scholar
  3. Culter JL, Ederer F (1968) Maximum utilization of the life table method in analysing survival. J Chron. Dis 8: 699Google Scholar
  4. Dubernard JM, Traeger J, Neyra P, Touraine JL, Tranchat D, Blanc Brunat N (1978) New method of preparation of a segmental pancreatic graft for transplantation. Trial in dogs and in man. Surgery 84: 633–639Google Scholar
  5. Mauer SM, Goetz FC, McHugh LE, Sutherland DER, Barbosa J, Najarian JS and Steffes MW (1989) Long-term study of normal kidneys transplanted into patients with type I diabetes. Diabetes 38: 516–523Google Scholar
  6. Nakache R, Tyden G, Groth CG (1989) Quality of life in diabetic patients after combined pancreas-kidney or kidney transplantation. Diabetes 38, suppl 1: 40–42Google Scholar
  7. Pozza G, Bosi E, Secchi A, Piatti PM, Touraine JL, Gelet A, Pontiroli A, Dubernard JM, Traeger J (1985) Metabolic control of type 1(insulin dependent) diabetes after pancreas transplantation. Br med J 291: 510–513Google Scholar
  8. Pozza G, Traeger J, Dubernard JM, Secchi A, Pontiroli A, Bosi E, Malik MC, Ruitton A, Blanc N (1983) Diabetologia 24: 244–248Google Scholar
  9. Ramsay RC, Goetz FC, Sutherland DER, Mauer SM, Robinson LL, Cantrill HL, Knobloch WH, Najarian JS (1988) Progression of diabetic retinopaty after pancreas transplantation for insulin dependent diabetes mellitus. N. Eng. J. Med. J 318, No4: 208–214Google Scholar
  10. Schleibner S, Welter H, Abendroth D et al (1988) Renal transplantation at the Munich transplant center a retrspective single center review. In:Terasaki P. Clin Transpl. 107–114Google Scholar
  11. Secchi A, Martinenghi S, Galardi G, Comi G, Canal N and Pozza G (1991) Effects of pancreatic transplantation on diabetic polyneuropathy. Transpl. Proc. 23, No 1: 1658–1659Google Scholar
  12. Simmons RG, Abress L, Anderson CR (1988) Rehabilitation after kidney transplantation. Oragan transplantation and replacement. In:Cerilli GJ. New York PlenumGoogle Scholar
  13. Solders G, Wilczek H, Gunnarson R, Tyden G, Persson A, Groth CG (1987) Effects of combined pancreatic and renal transplantation on diabetic neuropathy: a two year follow-up study. The Lancet 28: 1232–1235Google Scholar
  14. Sollinger HW, Stratta RJ, Kalayoglu M, Pirsch JD, Belzer FO (1987) Pancreas transplantation with pancreaticocystostomy and quadruple immunosuppression. Surgery 102, No 4: 674–679Google Scholar
  15. Sutherland DER, Moudry-Munns KC, Gillingham K (1989) Pancreas transplantation: Report from the International Registry and a Preliminary Analysis of United States Results from the New United Network for Organ Sharing (UNOS) Registry. In: Terasaki P. Clinical Transplant 19–43Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • A. Secchi
    • 1
  • V. Di Carlo
    • 2
  • S. Martinenghi
    • 1
  • E. La Rocca
    • 1
  • R. Caldara
    • 1
  • D. Spotti
    • 3
  • G. Slaviero
    • 3
  • C. Staudacher
    • 2
  • G. Ferrari
    • 2
  • G. Pozza
    • 1
  1. 1.Department of Internal MedicineIstituto Scientifico San RaffaeleMilanItaly
  2. 2.Department of SurgeryIstituto Scientifico San RaffaeleMilanItaly
  3. 3.Department of NephrologyIstituto Scientifico San RaffaeleMilanItaly

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