Effects of kidney-pancreas transplantation on atherosclerotic risk factorsand endothelial function in patients with uremia and type 1 diabetes

Cardiovascular disease and the development of coronary artery disease play a pivotal role in increasing mortality in patients with type 1 diabetes. Th e aim of our study was to evaluate the effects of pancreas transplantation on atherosclerotic risk factors, endothelial-dependent dilation (EDD), and progression of intima media thickness (IMT) in patients with uremia and typ e 1 diabetes after kidney-alone (KA) or kidney-pancreas (KP) transplantatio n. A cross-sectional study comparing two groups of patients with type 1 dia betes was performed. Sixty patients underwent KP transplantation and 30 pat ients underwent KA transplantation. Age and cardiovascular risk profile wer e comparable in patients before transplantation. In all patients, atheroscl erotic risks factors (lipid profile, fasting and post-methionine load plasm a homocysteine, von Willebrand factor levels, D-dimer fragments, and fibrin ogen) were assessed and Doppler echographic evaluation of IMT and endotheli al function with flow-mediated and nitrate dilation of the brachial artery was performed. Twenty healthy subjects were chosen as controls (C) for EDD. Compared with patients undergoing KA transplantation, patients undergoing KP transplantation showed lower values for HbA(1c) (KP = 6.2 +/- 0.1% vs. K A = 8.4 +/- 0.5%;P < 0.01), fasting homocysteine (KP = 14.0 +/- 0.7 <mu>mol /l vs. KA = 19.0 +/- 2.0 mu mol/l; P = 0.02), von Willebrand factor levels (KP = 157.9 +/- 8.6% vs. KA = 212.5 +/- 16.2%; P < 0.01), D-dimer fragments (KP = 0.29 +/- 0.02 <mu>g/ml vs. KA = 0.73 +/- 0.11 mug/ml; P < 0.01), fib rinogen (KP = 363.0 +/- 11.1 mg/dl vs. KA = 397.6 +/- 19.4 mg/dl; NS), trig lycerides (KP = 122.7 +/- 8.6 mg/dl vs. KA = 187.0 +/- 30.1 mg/dl; P = 0.01 ), and urinary albumin excretion rate (KP = 13.5 +/- 1.9 mg/24 h vs. KA = 5 7.3 +/- 26.3 mg/24 h; P < 0.01). Patients undergoing KP transplantation sho wed a normal EDD (KP = 6.21 +/- 2.42%, KA = 0.65 +/- 2.74%, C = 8.1 +/- 2.1 %;P < 0.01), whereas no differences were observed in nitrate-dependent dila tion. Moreover, IMT was lower in patients undergoing KP transplantation tha n in patients undergoing KA transplantation (KP = 0.74 +/- 0.03 mm vs. KA = 0.86 +/- 0.09 mm; P = 0.04). Our study showed that patients with type 1 di abetes have a lower atherosclerotic risk profile after KP transplantation t han after KA transplantation. These differences are tightly correlated with metabolic control, fasting homocysteine levels, lower D-dimer fragments, a nd lower von Willebrand factor levels. Normal endothelial function and redu ction of IMT was observed only in patients undergoing KP transplantation.