Long-term Metabolic Outcomes Post-Simultaneous Pancreas-Kidney Transplantation in Recipients With Type 1 Diabetes.

IF 5.3 2区医学 Q1 IMMUNOLOGY

Transplantation Pub Date : 2025-07-01 Epub Date: 2025-01-23 DOI:10.1097/TP.0000000000005334

Harsham Choksi, Henry Pleass, Paul Robertson, Eric Au, Natasha Rogers

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Abstract

Background: Simultaneous pancreas-kidney (SPK) transplantation is an effective treatment option for type 1 diabetes mellitus and concurrent end-stage kidney disease. However, the diabetogenic effects of immunosuppression can counteract the beneficial effects of sustained normoglycemia. Long-term metabolic trends that reflect cardiovascular risk are reported poorly in the literature.

Methods: A total of 500 patients with type 1 diabetes mellitus receiving SPK transplants at a single center with at least 2-y follow-up were evaluated retrospectively. Metabolic parameters and allograft function were followed longitudinally, including patient and allograft survival, body mass index (BMI), lipid profile, quantitative insulin sensitivity check index, estimated glomerular filtration rate, and urinary albumin-creatinine ratio up to 10 y posttransplant.

Results: Patient survival at 1, 5, and 10 y was 97%, 92%, and 87%, and overall death-censored graft survival was 87%, 84%, and 80%, respectively. Survival remained unchanged when stratified by BMI. Compared with pretransplant measurements, BMI significantly increased at 1, 3, and 5 y posttransplant. Total cholesterol, triglycerides, and low-density lipoprotein cholesterol decreased at 10 y posttransplant, with significantly increased high-density lipoprotein cholesterol at 5 y posttransplant. Insulin sensitivity improved significantly at 10 y posttransplant but did not normalize. Urinary albumin-creatinine ratio decreased by 3 y posttransplant but increased significantly between 3 and 10 y posttransplant, although the estimated glomerular filtration rate was unchanged during this time.

Conclusions: SPK transplantation is associated with excellent patient and graft survival. Significant long-term weight gain occurs despite improving lipid profiles and insulin sensitivity posttransplant. These data potentially reflect an overall cardiovascular burden that should be addressed in this population.

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1型糖尿病患者胰肾联合移植术后的长期代谢结局

背景：胰肾联合移植（SPK）是治疗1型糖尿病和并发终末期肾病的有效选择。然而，免疫抑制的致糖尿病作用可以抵消持续正常血糖的有益作用。反映心血管风险的长期代谢趋势在文献中报道较少。方法：对500例在同一中心接受SPK移植的1型糖尿病患者进行回顾性分析，随访时间至少2年。纵向跟踪代谢参数和同种异体移植物功能，包括患者和移植物存活、体重指数（BMI）、血脂、定量胰岛素敏感性检查指数、估计肾小球滤过率和移植后10年的尿白蛋白-肌酐比。结果：患者在1、5和10 y时的生存率分别为97%、92%和87%，总体死亡剔除的移植物生存率分别为87%、84%和80%。按BMI分层时，生存率保持不变。与移植前相比，BMI在移植后1、3和5年显著增加。总胆固醇、甘油三酯和低密度脂蛋白胆固醇在移植后10年下降，高密度脂蛋白胆固醇在移植后5年显著升高。胰岛素敏感性在移植后10年显著改善，但未恢复正常。尿白蛋白-肌酐比值在移植后3 y下降，但在移植后3 - 10 y显著上升，尽管在此期间肾小球滤过率没有变化。结论：SPK移植具有良好的患者和移植物存活率。尽管移植后血脂和胰岛素敏感性有所改善，但长期体重仍会显著增加。这些数据可能反映了这一人群应该解决的总体心血管负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation 医学-免疫学

CiteScore

8.50

自引率

11.30%

发文量

1906

审稿时长

1 months

期刊介绍： The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation.