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

• Published in: Diabetes care Vol. 23; no. 12; pp. 1804 - 1810
• Main Authors: FIORINA, Paolo, LA ROCCA, Ennio, SECCHI, Antonio, ASTORRI, Ettore, LUCIGNANI, Giovanni, ROSSETTI, Claudio, FAZIO, Ferruccio, GIUDICI, Daniela, DI CARLO, Valerio, CRISTALLO, Marco, POZZA, Guido
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.12.2000
• Subjects: Adult; Associated diseases and complications; Biological and medical sciences; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - surgery; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - surgery; Diastole; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Glycated Hemoglobin A - analysis; Humans; Hypertension - etiology; Hypertension - therapy; Insulin - blood; Kidney Transplantation; Medical sciences; Middle Aged; Pancreas Transplantation; Radionuclide Imaging; Triglycerides - blood; Uremia - surgery; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - therapy; Endocrinopathy; Human; Kidney disease; Immunopathology; Urinary system disease; Treatment efficiency; Cardiovascular disease; Autoimmune disease; Heart ventricle; Transplantation; Left ventricular failure; Kidney; Heart disease; Surgery; Renal failure; Insulin dependent diabetes; Adult; Pancreas; Uremia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.23.12.1804

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. Abstract 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.