Diabetes Care, Vol 23, Issue 12 1804-1810, Copyright © 2000 by American Diabetes Association

ARTICLES

Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients

P Fiorina, E La Rocca, E Astorri, G Lucignani, C Rossetti, F Fazio, D Giudici, V di Carlo, M Cristallo, G Pozza and A Secchi
Department of Internal Medicine, San Raffaele Scientific Institute, Milan, Italy.

OBJECTIVE: Diastolic function is frequently impaired in diabetic patients. Our aim was to evaluate the effects of glycometabolic control achieved by pancreas transplantation on left ventricular function in uremic type 1 diabetic patients. RESEARCH DESIGN AND METHODS: Left ventricular systolic and diastolic functions were evaluated using radionuclide ventriculography in 42 kidney-pancreas transplant patients and 26 kidney-alone recipients who had similar clinical characteristics before transplantation. Patients were grouped according to 6, 24, and 48 months of follow-up. Control subjects consisted of 20 type 1 diabetic patients. RESULTS: The left ventricular ejection fraction was normal in all of the patients. However, kidney-pancreas transplant patients with 4 years of graft function had a higher ejection fraction (75.7 +/- 1.8%) than kidney-alone patients with 4 years of graft function (65.3 +/- 2.8%, P = 0.02) and type 1 diabetic patients (61.3 +/- 3.7%, P = 0.004). In patients with 4 years of graft function, normal diastolic parameters were evident in kidney-pancreas but not in kidney-alone or in type 1 diabetic patients (peak filling rate: 4.46 +/- 0.15 end diastolic volume (EDV)/s in kidney-pancreas patients vs. 2.73 +/- 0.24 EDV/s [P < 0.01] and 3.39 +/- 0.30 EDV/s [P < 0.01] in kidney-alone and type 1 diabetic patients, respectively; time-to-peak filling rate: 141.9 +/- 7.8 ms in kidney-alone patients vs. 209.4 +/- 13.5 ms in kidney-alone patients [P < 0.01]; peak filling rate/peak ejection rate ratio: 1.10 +/- 0.04 in kidney-pancreas patients vs. 0.81 +/- 0.08 in kidney-alone patients [P < 0.01]). A significant reduction in diastolic dysfunction rate was observed only in kidney-pancreas patients. CONCLUSIONS: Kidney-pancreas transplantation results in complete insulin independence, a better glycometabolic pattern and blood pressure control, an improvement of left ventricular function, and a reversal of diastolic dysfunction.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. E. Gilbert, K. Connelly, D. J. Kelly, C. A. Pollock, and H. Krum Heart Failure and Nephropathy: Catastrophic and Interrelated Complications of Diabetes Clin. J. Am. Soc. Nephrol., March 1, 2006; 1(2): 193 - 208. [Abstract] [Full Text] [PDF]

				G. Perseghin, P. Fiorina, F. De Cobelli, P. Scifo, A. Esposito, T. Canu, M. Danna, C. Gremizzi, A. Secchi, L. Luzi, et al. Cross-Sectional Assessment of the Effect of Kidney and Kidney-Pancreas Transplantation on Resting Left Ventricular Energy Metabolism in Type 1 Diabetic-Uremic Patients: A Phosphorous-31 Magnetic Resonance Spectroscopy Study J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1085 - 1092. [Abstract] [Full Text] [PDF]

				P. Fiorina, C. Gremizzi, P. Maffi, R. Caldara, D. Tavano, L. Monti, C. Socci, F. Folli, F. Fazio, E. Astorri, et al. Islet Transplantation Is Associated With an Improvement of Cardiovascular Function in Type 1 Diabetic Kidney Transplant Patients Diabetes Care, June 1, 2005; 28(6): 1358 - 1365. [Abstract] [Full Text] [PDF]

				J. L. Larsen Pancreas Transplantation: Indications and Consequences Endocr. Rev., December 1, 2004; 25(6): 919 - 946. [Abstract] [Full Text] [PDF]

				J. L. Larsen, C. W. Colling, T. Ratanasuwan, T. W. Burkman, T. G. Lynch, J. M. Erickson, E. R. Lyden, J. T. Lane, and L. R. Mack-Shipman Pancreas Transplantation Improves Vascular Disease in Patients With Type 1 Diabetes Diabetes Care, July 1, 2004; 27(7): 1706 - 1711. [Abstract] [Full Text] [PDF]