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Copyright ©The Author(s) 2019.
World J Transplant. Aug 26, 2019; 9(4): 81-93
Published online Aug 26, 2019. doi: 10.5500/wjt.v9.i4.81
Table 3 Sample of studies evaluating the effect of pancreatic transplantation on the complications of diabetes mellitus
Ref.Patient cohortsOutcomes of interestTime after transplant (yr)Results
Cardiovascular disease
Fiorina et al[9], 2000SPK (n = 42) vs KTA (n = 26) vs type 1 diabetes (n = 20)Left ventricular systolic and diastolic function assessed by radionuclideventriculography4 yrLeft ventricular ejection fraction was higher in SPK recipients than in KTA recipients [75.7 (SD 1.8%) vs 65.3% (2.8%); P = 0.02] and type 1 diabetes controls (75.7 (1.8%) vs 61.2 (3.7%); P = 0.004).
Biesenbach et al[10], 2005SPK (n = 12) vs KTA (n = 10)Composite endpoint of myocardial infarction, stroke, and amputation10 yrLower incidence of myocardial infarction (16% vs 50%), stroke (16% vs 40%), and amputations (16% vs 30%) in SPK vs KTA recipients (P < 0.05 for composite endpoint of all three events)
Diabetic nephropathy
Fioretto et al[11], 1998PTA: Pre-transplant vspost-transplant (n = 8)Native kidney biopsy:structural morphology10 yrImprovement in glomerular basement membrane thickening, tubular basement membrane thickening, and mesangial expansion after transplantation compared with before
before and after transplant
Boggi et al[12], 2011PTA: Pre-transplant vs post-transplant (n = 71)Proteinuria and estimatedGFR (eGFR)Up to 4 yrOverall, proteinuria decreased from 1.36 (SD 2.72) g/d pre-transplant to 0.29 (0.51) g/d post-transplant (P < 0.01) eGFR decreased by about 20% from 94 (39) mL/min per 1.73m2 to 75 (22) mL/min per 1.73 m2 (P < 0.01)
Diabetic neuropathy
Havrdova et al[13], 2016SPK: Pre-transplant vspost-transplant (n = 12)Epidermal nerve fiberdensity on skin biopsy, autonomic function tests, and nerve conduction studiesUp to 8 yrNo improvement in epidermal nerve fiber density or functional deficits on autonomic function tests
Boggi et al[12], 2011PTA: Pre-transplant vspost-transplant (n = 71)Clinical neurologicexamination (vibration threshold), nerve conduction studies, and autonomic function tests (lying-to-standing test)Up to 4 yrSignificant improvement in mean vibration thresholds, nerve conduction studies, and autonomic function tests after PTA compared with before
Diabetic retinopathy
Boggi et al[12], 2011PTA: Pre-transplant vs post-transplant (n = 71)Visual acuity scores andfundoscopic examinationUp to 4 yrBefore transplantation, 7.5% of patients had no retinopathy and remained lesion-free at 4 yr. Of the 29.5% with non-proliferative retinopathy, 75% improved and 25% remained unchanged. In the remainder with proliferative retinopathy, lesions remained stable in 82% and progressed in 18%
Giannarelli et al[14], 2006PTA (n = 33) vs type 1 diabetes (n = 35)Visual acuity scores, fundoscopic examination, and angiography in selected casesUp to 30 moBefore transplant, 9% of patients with PTA and 6% of those with type1 diabetes had no retinopathy, 24% and 29% had non-proliferative retinopathy, and 67% and 66% had proliferative retinopathy. Overall, the percentage of patients with improved or stabilized retinopathy was significantly higher in the PTA group (P < 0.01)
Koznarova et al[15], 2000SPK (n = 43) Vs KTA (n = 45)Visual acuity scores and fundoscopic examination3 yrIn the SPK group, fundoscopic findings at the end of follow-up had improved, stabilized, or deteriorated in 21.3%, 61.7%, and 17.0%, respectively. In the KTA group these figures were 6.1 %, 48.8%, and 45.1% (P < 0.001)