GRAFT SURVIVAL, VASCULAR FUNCTION AND HYPERTROPHY IN UREMIC TYPE 1 DIABETIC PATIENTS: IMPACT OF SUCCESSFUL ISLET CO-TRANSPLANTATION. A ROLE FOR NOS PATHWAYS

Abstract

P441 Aims: Diabetes and immunosuppression can reduce the survival of the kidney graft. Our aim was to evaluate survival, hypertrophy and vascular function of the kidney graft in uremic type 1 diabetic patients (U+T1DM) after transplant. Methods: The study population consisted of 234 U+T1DM who underwent kidney-pancreas (KP: 166 patients), successful kidney-islet (KI-s: 24 patients) and kidney (KD: 44 patients) transplant. Kidney size, graft survival and vascular function were evaluated prospectively for 6 years. Kidney biopsies were obtained cross-sectionally. Results: The KP and KI-s groups had better cumulative kidney graft survival at 6 years than did the KD group (KP: 73%; KI-s: 86%; KD: 42%; P<0.01). The KP group, but not KI-s/KD showed a persistent kidney graft hypertrophy up to 6 years of follow-up. A significant increase in creatinine levels from baseline to year 6 was evident in the KD group (1.58±0.08 to 2.78±0.44 mg/dl, P<0.05), but not in the KP/KI-s groups. The KP/KI-s groups only showed a reduction of renal resistance index from baseline to year 6 (KP at baseline: 0.74±0.01 to: 0.68±0.01 %, P<0.01; KI-s at baseline: 0.72±0.02 to: 0.69±0.02 %, P<0.05). At year 6 an increase from baseline in urinary albumin excretion was observed only in the KD group (31.4±9.0 mg/L to 82.9±33.6 mg/L, P<0.05). Graft NOs expression was higher in the KP/KI-s groups, compared to KD group. Conclusions: In U+T1DM, KP and to a lesser extent KI-s compared to KD, resulted in enhanced kidney graft survival, hypertrophy and vascular function.