Improved survival in patients with insulin-dependent diabetes mellitus andend-stage diabetic nephropathy 10 years after combined pancreas and kidneytransplantation.

Background The purpose of pancreatic transplantation in insulin-dependent d iabetic patients is to restore normoglycemia and thereby prevent the second ary complications of diabetes, However, uncertainty remains as to whether t he mortality rate in diabetic patients can be affected by this procedure. Method. We followed 14 patients with insulin dependent diabetes mellitus (I DDM) and end-stage diabetic nephropathy for 10 years after successful combi ned kidney and pancreas transplantation. Fifteen diabetic patients subjecte d to kidney transplantation alone have served as controls. The glycemic con trol has been studied annually for 10 years and diabetic polyneuropathy has been assessed in both groups after 2, 4, and 8 years, Results. In recipients of pancreas-kidney grafts, metabolic control was mai ntained throughout the observation period, with values of glycated hemoglob in ill the normal range. In contrast, glucose metabolism was impaired in th e control group, with glycated hemoglobin values around 10%, Nerve conducti on and parasympathetic autonomic dysfunction improved in both groups after 2 years; there was no difference between the groups, After 4 years, we foun d a significant difference between the study group and the control group, a nd after 8 years it had widened, At the 4-year evaluation, there was no dif ference in mortality: between the groups, At 8 years, however, a significan t difference was noted, which was further substantiated at 10 years with a 20% mortality rate in the pancreas-kidney group versus an 80% mortality in the kidney alone group. Conclusions. We found a substantial reduction in mortality in IDDM patients 10 years after successful combined pancreas and kidney transplantation. We speculate that the decrease in mortality was due to the beneficial effect of long-term normoglycemia on diabetic late complications and suggest there fore that combined pancreas and kidney transplantation, rather than kidney transplantation alone, should be offered to IDDM patients with end-stage di abetic nephropathy.