Abstract
It is not fully elucidated whether the restoring of normal glucose metabolism after successful simultaneous pancreas-kidney transplantation (SPK) improves vascular wall morphology and function in type 1 diabetic (T1D) patients. Therefore, we compared arterial stiffness, assessed by pulse wave velocity (PWV), carotid intima-media thickness (IMT), and biomarkers of arterial wall calcification in T1D patients after SPK or kidney transplantation alone (KTA). In 39 SPK and 39 KTA adult patients of similar age, PWV, IMT, circulating matrix metalloproteinases (MMPs) and calcification biomarkers were assessed at median 83 months post transplantation. Additionally, carotid plaques were visualized and semi-qualitatively classified. Although PWV and IMT values were similar, the occurrence of atherosclerotic plaques (51.3 vs. 70.3%, p < 0.01) and calcified lesions (35.9 vs. 64.9%, p < 0.05) was lower in SPK patients. There were significantly lower concentrations of MMP-1, MMP-2, MMP-3, and osteocalcin in SPK subjects. Among the analyzed biomarkers, only logMMP-1, logMMP-2, and logMMP-3 concentrations were associated with log HbA1c. Multivariate stepwise backward regression analysis revealed that MMP-1 and MMP-3 variability were explained only by log HbA1c. Normal glucose metabolism achieved by SPK is followed by the favorable profile of circulating matrix metalloproteinases, which may reflect the vasoprotective effect of pancreas transplantation.
Highlights
Simultaneous pancreas and kidney transplantation (SPK) is the treatment of choice in patients with type 1 diabetes (T1D) and end-stage renal disease
The main finding of our present study is the demonstration of significantly lower concentration of circulating metalloproteinases (MMP-1, matrix metalloproteinases (MMPs)-2, and MMP-3) in simultaneous pancreas-kidney transplantation (SPK)
Recipients as compared with kidney transplantation alone (KTA) patients, which potentially may reflect the beneficial changes in the vascular wall related to the normalization of glucose metabolism
Summary
Simultaneous pancreas and kidney transplantation (SPK) is the treatment of choice in patients with type 1 diabetes (T1D) and end-stage renal disease This procedure results in improved T1D patient survival as compared to kidney transplant alone (KTA) [1] even in case of those who received kidney graft from living donors [2,3]. The endothelial function assessed by brachial flow-mediated dilation and plasma nitrites level was more improved in SPK recipients than in KTA patients [11]. Both the arterial stiffness measured by pulse wave velocity (PWV) and the levels of serological markers of endothelial dysfunction were still elevated in a mid-term observation after successful SPK [12]. There are no data demonstrating whether long-term better glycemic control after successful SPK improves vascular wall morphology in T1D patients
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