Cardiovascular outcomes after kidney-pancreas and kidney-alone transplantation

Background. This study retrospectively assessed, with an intention-to-treat analysis, the effect of kidney-pancreas transplantation (KP) on survival a nd cardiovascular outcome in type 1 diabetic uremic patients. Methods. A total of 351 uremic type 1 diabetic patients were enrolled on a waiting list for KP: 130 underwent KP transplantation, 25 underwent kidney transplantation alone (KA), whereas 196 patients remained on dialysis (WL). The three populations had similar cardiovascular conditions. Actuarial sur vival rates and causes of death were recorded over a period of seven years. Finally, 23 KP and 13 KA patients underwent left radionuclide ventriculogr aphy, during a follow-up of four years. Results. In the entire group of 351 patients the seven-year survival rate w as 77.4% for KP, 56.0% for KA and 39.6% for WL (KP vs. WL, P = 0.01). Cardi ovascular death rate was 7.6% in KP, 20.0% in KA and 16.1% in WL (KP versus WL, P = 0.03; KP vs. KA, P = 0.16). In the subsample studied with radionuc lide ventriculography, left ventricular ejection fraction improved in KP, b ut did not in KA, with significant differences between groups at two and fo ur years. At four years only the KP patients presented normal values of dia stolic parameters, including the peak filling rate, time-to-peak filling ra te, and peak filling rate/peak ejection rate ratio. Glycated hemoglobin was negatively associated with the ejection fraction, peak filling rate and pe ak filling rate/peak ejection rate ratio, and positively associated with th e time-to-peak filling rate. Conclusions. Normalization of blood glucose metabolism and improvement of b lood pressure control obtained with KP transplant is associated with positi ve effects on survival, cardiovascular death rate, and left ventricular fun ction.