Endocrine Abstracts

Long-term benefit-risk ratio of IT remains poorly evaluated. The aim of this work was to determine the evolution of macroangiopathic complications 5 years after IT.

21 out of the 36 prospectively followed islet-transplanted patients in a single center, had at least 5 years of follow-up and were included. Their initial features were: duration of C-peptide negative diabetes: 28±9years; age: 43±7years; BMI: 24±0.2 kg/m2; 8/21 kidney-transplanted patients for 23±10 months; immunosuppression: Edmonton. These 21 patients had a systematic screening for macroangiopathy before transplantation, and then yearly for 5 years. Three «islet-alone » and 2 « islet-after-kidney» patients had lost their islet function at 5 years. Nine patients were insulin-independent, 8/9 with HbA1c ≤ 6.5% (38% with both criteria). The mean HbA1c level was 8.1±1.0% before vs. 7.1±1.0% 5 years after IT (P<0.01). Analyses were performed in intention-to-treat. There was no loss of follow-up.

The mean level of cholesterol total (1.86±0.37vs.1.76±0.36g/l), HDL (0.71±0.18vs. 0.73±0.27g/l), LDL (0.98±0.32vs.0.88±0.30g/l), triglycerides (0.79±0.33vs.0.83±0.34g/l) and mean blood pressure (124±17/72±7 vs. 127±13/72±8 mmHg) did not differ before vs. after transplantation (patients treated with statins: 28% vs. 65% and with ≧ 1 antihypertensive drug: 38% vs. 75%). Three patients among whom 2 « islet-after-kidney» had macroangiopathic complications before transplantation (2 femoral by-passes among which 1 with amputation, 1 coronary stent). There were no clinical acute cardiovascular events during these 5 years., Macroangiopathic screening was abnormal before vs. after transplantation for: carotid ultrasound: 37%vs.52%; lower limb ultrasound: 36%vs.85% (22 vs 25% if mediacalcosis was excluded), non-invasive test for cardiac ischemia: 19% (with 3 normal coronarographies except for 1 calcification) vs. 24% (among which 4 stented). Conclusion: IT was not associated with acute clinical cardiovascular event in these 21 patients with long-lasting diabetes, among whom 8 kidney-transplanted at the expense of systematic screening and treatment of macroangiopathic complications.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.