ECE2022 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (202 abstracts)
Simultaneous pancreas-kidney transplantation: long-term survival and metabolic profile analysis among functioning pancreatic graft patients – A 20 year experience from a center in Portugal
Ariana Maia 1 , Miguel Saraiva 1 , Inês Sala 2 , Daniela Soares 1 , Diana Borges Soares 1 , Sílvia Monteiro 1 , Joana Vilaverde 1 , Lia Ferreira 1 , La Salete Martins 2 & Jorge Dores 1
1Centro Hospitalar Universitário do Porto, Serviço de Endocrinologia, Diabetes e Metabolismo, Porto, Portugal; 2Centro Hospitalar Universitário do Porto, Serviço de Nefrologia, Porto, Portugal
Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for type 1 diabetic patients with advanced kidney chronic disease (CKD), restoring normoglycemia, insulin independence and improving survival. The present study aims to analyse survival of patients undergoing SPKT and the post-SPKT metabolic profile of patients with a functioning pancreatic graft.
Methods: Retrospective observational study. T1DM patients with CKD stages 4-5 KDIGO undergoing SPKT at Centro Hospitalar Universitário do Porto from May 2000 to November 2020 were included. Pre-SPKT baseline data collection. Survival analyses were performed using Kaplan-Meier method. Metabolic profile of patients with a functioning pancreatic graft was secondarily investigated in the latest post-SPKT medical visit.
Results: 242 patients were included with a mean age at SPKT of 35.4 ± 6.1 years, mean duration of DM and dialysis of 24.1±5.9 years and 25.8±19.5 months, respectively. Patients had mean values of HbA1c, total daily insulin dose (TDID) and BMI of 8.5±1.6 %, 38.8 ± 12.5 U/day and 22.4 ± 2.8 kg/m2 pre-SPKT. Cumulative patient survival was 96.3%, 94.4%, 90.1%, 83.4%, and 80.6% at 1, 5, 10, 15, and 20 years post-SPKT. Pancreatic graft survival of 85.5%, 79.4%, 74.5%, 65.0% and 61.8% at 1, 5, 10, 15 and 20 years. Renal graft survival of 93.8%, 88.6%, 80.1% and 73.5% at 1, 5, 10 and 20 years. The main causes of failure were graft rejection and thrombosis. The metabolic profile of the individuals analysed at the most recent post-SPKT consultation included 178 patients with functioning pancreatic graft, with a mean follow-up of 9.3±5.2 years post-SPKT, and of these, 94.4% with functioning renal graft. Mean BMI, creatinine clearance, C-peptide, HbA1c, LDL-cholesterol and non-HDL-cholesterol were 23.7±4.0 Kg/m2, 63.8±21.2 ml/min/1,73 m2, 3.1±2.0 ng/ml, 5.6±0.7%, 89.0±35.3 mg/dl and 111.3±40.0 mg/dl. Intermediate hyperglycaemia was present in 29.8% of patients and 5.1% had HbA1c ≥ 6.5%.
Conclusion: Results of our center reinforce SPKT as a valid option in the treatment of T1DM, aiming to improve quality of life, with sustained maintenance of euglycemia, without the need for exogenous insulin, in the medium/long term within a selected group of patients with advanced diabetic kidney disease.
Keywords: Type 1 diabetes mellitus, simultaneous pancreas and kidney transplantation, transplant, transplantation, chronic complications of diabetes, metabolic profile.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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