Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy.
Transplantation. 2022 Jan 1;106(1):147-157. doi: 10.1097/TP.0000000000003627.
Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects.
This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys.
Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed.
These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.
通过胰岛或胰腺移植，1 型糖尿病（T1D）患者可以实现生理性调节的胰岛素分泌和血糖正常。然而，单独进行胰腺移植（PTA）仍然存在争议，其相对益处和风险尚不确定。我们确定了在经过精心特征描述的 T1D 患者中，PTA 的实际长期（10 年）疗效和安全性。
这是一项单中心队列研究，纳入了 2001 年 4 月至 2007 年 12 月期间接受 PTA 的 66 例连续 T1D 患者，并对其进行了 10 年随访。主要评估的特征包括患者生存、胰腺移植物功能、C 肽水平、血糖参数以及原肾的功能。
10 年实际患者生存率为 92.4%。57.4%和 3.2%的患者分别观察到最佳（胰岛素独立性）或良好（最小胰岛素需求）移植物功能。6（9.0%）例患者发展为 5 期或 4 期慢性肾脏病。在其余成功进行 PTA 的患者中，每年估算肾小球滤过率（eGFR）下降-2.29±2.69mL/min/1.73m2。在 PTA 前存在高滤过和较高 HbA1c 浓度的患者中，PTA 后 1 年 eGFR 下降幅度更高；此后 eGFR 的变化与糖尿病病程显著相关。在 10 年时血糖正常的患者中，74%的 PTA 前正常白蛋白尿或微量白蛋白尿患者保持稳定，26%进展为更差的阶段；相反，在 62.5%的大量白蛋白尿患者中，蛋白尿严重程度有所减轻。
这些 PTA 对患者生存、移植物功能和原肾的长期影响支持将 PTA 作为治疗选定 T1D 患者糖尿病的一种合适方法。
