Abstract
BackgroundCoronary heart disease due to arteriosclerosis is the leading cause of death in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to evaluate the effect of simultaneous pancreas kidney transplantation (SPKT) compared to kidney transplantation alone (KTA) on survival, cardiovascular function and metabolic outcomes.MethodsA cohort of 127 insulin-dependent diabetes mellitus (IDDM) patients with ESRD who underwent either SPKT (n = 100) or KTA (n = 27) between 1998 and 2019 at the University Hospital of Leipzig were retrospectively evaluated with regard to cardiovascular and metabolic function/outcomes as well as survival rates. An additional focus was placed on the echocardiographic assessment of systolic and diastolic cardiac function pretransplant and during follow-up. To avoid selection bias, a 2:1 propensity score matching analysis (PSM) was performed.ResultsAfter PSM, a total of 63 patients were identified; 42 patients underwent SPKT, and 21 patients received KTA. Compared with the KTA group, SPKT recipients received organs from younger donors (p < 0.05) and donor BMI was higher (p = 0.09). The risk factor-adjusted hazard ratio for mortality in SPKT recipients compared to KTA recipients was 0.63 (CI: 0.49–0.89; P < 0.05). The incidence of pretransplant cardiovascular events was higher in the KTA group (KTA: n = 10, 47% versus SPKT: n = 10, 23%; p = 0.06), but this difference was not significant. However, the occurrence of cardiovascular events in the SPKT group (n = 3, 7%) was significantly diminished after transplantation compared to that in the KTA recipients (n = 6, 28%; p = 0.02). The cardiovascular death rate was higher in KTA recipients (19%) than in SPK recipients with functioning grafts (3.3%) and comparable to that in patients with failed SPKT (16.7%) (p = 0.16).In line with pretransplant values, SPKT recipients showed significant improvements in Hb1ac values (p = 0.001), blood pressure control (p = < 0.005) and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (p = < 0.005) 5 years after transplantation. With regard to echocardiographic assessment, SPKT recipients showed significant improvements in left ventricular systolic parameters during follow-up.ConclusionsNormoglycaemia and improvement of lipid metabolism and blood pressure control achieved by successful SPKT are associated with beneficial effects on survival, cardiovascular outcomes and systolic left ventricular cardiac function. Future studies with larger samples are needed to make predictions regarding cardiovascular events and graft survival.
Highlights
Diabetes mellitus (DM) remains the predominant risk factor for the development of chronic kidney disease (CKD), followed by end-stage renal disease (ESRD) [1]
Normoglycaemia and improvement of lipid metabolism and blood pressure control achieved by suc‐ cessful simultaneous pancreas kidney transplantation (SPKT) are associated with beneficial effects on survival, cardiovascular outcomes and systolic left ventricular cardiac function
In diabetic ESRD, dyslipidaemia and a body mass index (BMI) > 25 kg/m2 are additional risk factors for developing cardiovascular disease (CVD) and subsequent increased morbidity and mortality. Researchers suggest that this increase is related to diffuse peripheral coronary arteriosclerosis and higher left ventricular mass in diabetic patients compared to controls [5, 6]; diabetes mellitus can cause functional and structural changes in the myocardium without coronary artery disease, a disorder known as diabetic cardiomyopathy (DCM) [7]
Summary
Diabetes mellitus (DM) remains the predominant risk factor for the development of chronic kidney disease (CKD), followed by end-stage renal disease (ESRD) [1]. The significantly increased risk is explainable through overrepresentation of arteriosclerosis risk factors These risk factors include arterial hypertension caused by dysregulation of the renin–angiotensin–aldosterone system (RAAS) and electrolyte imbalance due to failing renal function. In diabetic ESRD, dyslipidaemia and a body mass index (BMI) > 25 kg/m2 are additional risk factors for developing CVD and subsequent increased morbidity and mortality. Researchers suggest that this increase is related to diffuse peripheral coronary arteriosclerosis and higher left ventricular mass in diabetic patients compared to controls [5, 6]; diabetes mellitus can cause functional and structural changes in the myocardium without coronary artery disease, a disorder known as diabetic cardiomyopathy (DCM) [7]. The aim of this study was to evaluate the effect of simultaneous pancreas kidney transplantation (SPKT) compared to kidney transplantation alone (KTA) on survival, cardiovascular function and meta‐ bolic outcomes
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