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  • 1
    Electronic Resource
    Electronic Resource
    Effect of pancreas transplantation on diabetic retinopathy: a 20-case report (1991)
    Springer
    Diabetologia 34 (1991), S. S92 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic retinopathy ; Metabolic control ; Kidney and pancreas transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to study the effects of normoglycaemia on diabetic retinopathy, 20 diabetic uraemic patients who underwent a kidney-pancreas transplantation were evaluated before and after surgery (6,9 months and once a year). The control group consisted of 12 uraemic patients who underwent kidney transplantation alone. At each follow-up examination a complete clinical examination and a retinal fluorescein angiography were performed. The eyes with end-stage retinopathy at baseline were excluded from the study. The analysis of the results showed no significant differences in the two groups. The diabetic retinopathy at the moment of the transplantation was already too advanced to benefit from the better glycaemic control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587629
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  • 2
    Electronic Resource
    Electronic Resource
    Neurophysiological study of the effect of combined kidney and pancreas transplantation on diabetic neuropathy: a 2-year follow-up evaluation (1991)
    Springer
    Diabetologia 34 (1991), S. S103 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; Kidney transplantation ; Diabetic neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Previous study have reported a significant improvement of peripheral neuropathy following combined pancreas and kidney transplantation attributed to improvement of blood glucose control by some authors and to elimination of uraemia by others. To asses the specific role of uraemia and hyperglycaemia in neuropathy, 16 diabetic uraemic patients with combined pancreas and kidney transplantation were compared to 9 diabetic patients with a renal graft only. Neurophysiological studies of peripheral neuropathy included ulnar and deep peroneal nerve motor conduction velocity, median and sural nerve sensory conduction velocity were performed at baseline and 1 and 2 years after transplantation. One year after transplantation mean nerve conduction velocity significantly improved in both groups. However, changes were statistically significant in the kidney-pancreas group only. At the 2 year follow-up nerve conduction velocity had increased further in the pancreas-kidney group only. These data suggest that improvement of nerve conduction velocity following pancreas and kidney transplantation is predominantly due to the long-term euglycaemic state.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587632
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  • 3
    Electronic Resource
    Electronic Resource
    Mono-oligoclonal immunoglobulin abnormalities in diabetic patients after kidney transplantation: influence of simultaneous pancreas graft (1998)
    Springer
    Diabetologia 41 (1998), S. 1176-1179 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Pancreas transplantation ; kidney transplantation ; monoclonal immunoglobulins ; immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Monoclonal components (MC) are detected in as high as 30 % of renal transplant recipients. Our aim was to evaluate the incidence, relevance and consequence of monoclonal components in patients with Type I (insulin-dependent) diabetes who received kidney (n = 22), kidney and whole pancreas (n = 41), kidney and segmental pancreas (n = 24) and kidney and islets (n = 12) transplants. Immunosuppression was based on prophylactic anti-lymphocyte globulins, corticosteroids, azathioprine and cyclosporin in all patients; acute rejection was treated with steroids or anti-lymphocyte monoclonal immunoglobulin therapy (OKT3) or both. Serum immunofixation was carried out in all patients before transplantation and then after at 6 months and then yearly. Monoclonal components were detected in 81 of 99 patients (82 %); 52 patients (52 %) developed them within 6 months of transplantation, 15 (15 %) between 6 and 12 months, with a peak prevalence at 1 year post-transplant (58 %) and a decrease thereafter (10 % at 9 years). Kidney recipients showed a lower incidence of monoclonal components when compared with those who received kidneys and segmental pancreases and those who received kidneys and whole pancreases. Monoclonal components were more often detected in patients who had previously experienced an acute renal rejection. Cytomegalovirus infection and acute rejection occurring in the same patient further increased the risk of developing monoclonal components, the development of which did not correlate with OKT3 treatment. A Post-transplant lymphoproliferative disorder was developed by two patients (2 %), one with 5 and the other with 6 monoclonal components. In conclusion, diabetic patients receiving kidney and/or Pancreas transplantation, experiencing both cytomegalovirus infection and acute rejection, are at greatest risk of developing monoclonal components but they appear to be benign and transient; multiple band detection is a marker for the subsequent development of post-transplant lymphoprolifertive disorder. [Diabetologia (1998) 41: 1176–1179]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051048
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  • 4
    Electronic Resource
    Electronic Resource
    Reduction of insulin resistance by combined kidney-pancreas transplantation in Type 1 (insulin-dependent) diabetic patients (1990)
    Springer
    Diabetologia 33 (1990), S. 549-556 
    Details
    ISSN: 1432-0428
    Keywords: Insulin resistance ; pancreas transplantation ; indirect calorimetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate the effect of combined kidney and pancreas transplantation on insulin action and glucose metabolism, 15 Type 1 (insulin-dependent) diabetic patients who were undergoing combined kidney-pancreas transplantation were studied before transplantation by means of the euglycaemic hyperinsulinaemic clamp technique combined with 3-3H-glucose infusion and indirect calorimetry. Nine of the original 15 patients were studied again after four months and six after 12 months, successful combined kidney-pancreas transplantation with the same experimental protocol. Nine volunteers formed the group of normal subjects. Combined kidney-pancreas transplantation normalised hepatic glucose production and reduced peripheral insulin resistance in Type 1 diabetic uraemic patients, despite chronic immunosuppressive therapy. To further evaluate the hypothesis that residual insulin resistance was due to chronic steroid therapy, 11 additional subjects with chronic uveitis (six of whom were treated with only prednisone, and five treated only with cyclosporin) underwent the same protocol demonstrating a normal hepatic glucose production. The insulin-stimulated peripheral glucose uptake was reduced in the prednisone-treated group, but normal in cyclosporin-treated subjects. Four additional diabetic patients with a kidney transplant were also studied. They showed a peripheral insulin sensitivity intermediate between diabetic uraemic patients and patients after combined transplant. We conclude that short-term (one year) combined kidney-pancreas transplantation improves glucose metabolism by restoring normal rates of hepatic glucose production and reducing peripheral insulin resistance; chronic steroid therapy is the major determinant of residual reduced insulin action. Both kidney and pancreas substitution play a role in reducing peripheral insulin resistance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00404143
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  • 5
    Electronic Resource
    Electronic Resource
    Thirty months' experience with cyclosporin in human pancreatic transplantation (1984)
    Springer
    Diabetologia 27 (1984), S. 154-156 
    Details
    ISSN: 1432-0428
    Keywords: Type 1 diabetes ; cyclosporin ; pancreatic transplantation ; renal transplantation ; immunosuppression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Between September 1978 and December 1983, 33 simultaneous kidney plus pancreatic transplantations were performed in Type 1 (insulin-dependent) diabetic patients with uraemia at the Herriot Hospital, Lyon. In eight patients grafted before June 1981, immunosuppressive treatment consisted of azathioprine, steroids and a temporary course with anti-lymphocyte globulins (protocol A). Since June 1981, the immunosuppressive treatment has consisted of cyclosporin administered according to two protocols: from the day of transplantation with temporary anti-lymphocyte globulins with or without steroids (protocol B, seven patients), or after an initial course with protocol A, with or without steroids (protocol C, 18 patients). Only slight differences in patient and pancreatic graft survival between the three protocols were observed at 3, 6 and 12 months, while an improved survival rate for both patients and pancreatic grafts was observed in protocols B and C at 2 years. Moreover the incidence of pancreatic rejection as a cause of loss of pancreatic function seemed to be reduced under protocols B and C.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00275676
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  • 6
    Electronic Resource
    Electronic Resource
    First peak insulin release after intravenous glucose and arginine is maintained for up to 3 years after segmental pancreas transplantation (1991)
    Springer
    Diabetologia 34 (1991), S. S53 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; intravenous glucose tolerance test ; oral glucose tolerance test ; arginine test
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In this study we have investigated blood glucose and serum free insulin response to glucose and to arginine orally or intravenously, 3 months and 3 years after a successful segmental, neoprene-injected, pancreas transplantation. Serum insulin responses to different secretagogues were normal 3 months after transplantation; they remained normal up to 3 years after transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587620
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  • 7
    Electronic Resource
    Electronic Resource
    Metabolic control after kidney and pancreas transplantation: whole series results and effects of segmental duct obstruction versus whole pancreas with bladder diversion technique (1991)
    Springer
    Diabetologia 34 (1991), S. S51 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplantation ; Bladder diversion ; Oral Glucose Tolerance Test ; Type 1 (insulin-dependent) diabetes mellitus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary From October 1976 to December 1990 181 pancreatic transplants were performed in our centre on 171 Type 1 (insulin-dependent) diabetic patients. Oral glucose tolerance test evaluated 1 year after surgery in 31 subjects showed an impaired glucose tolerance at 120 min (blood glucose 9.5±0.6 mmol/l). Similar results were obtained in seven patients 3 years after transplantation (blood glucose at 120 min 8.3±1.08 mmol/l). 24h metabolic profiles performed at the same intervals showed near normal blood glucose levels and good insulin release. Preliminary data concerning a randomized, comparative study between whole pancreas with bladder diversion and segmental pancreas transplantation, showed better metabolic control in the patients who received the whole pancreas, probably due to the greater islet mass grafted.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587619
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  • 8
    Electronic Resource
    Electronic Resource
    Effect of pancreas transplantation on life expectancy, kidney function and quality of life in uraemic Type 1 (insulin-dependent) diabetic patients (1991)
    Springer
    Diabetologia 34 (1991), S. S141 
    Details
    ISSN: 1432-0428
    Keywords: Kidney transplantation ; Pancreas transplantation ; Life expectancy ; Quality of life
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of our study was to evaluate the effects of haemodialysis, kidney transplantation and simultaneous kidney and pancreas transplantation on survival of diabetic subjects and on kidney function. 40 Type 1 (insulin-dependent) diabetic patients received a kidney transplantation: in 31 cases the kidney was transplanted simultaneously to a pancreas graft from the same donor (KP group), while in 9 cases the pancreas was not available (K group). 44 uraemic Type 1(insulin-dependent) diabetic patients on dialysis and in waiting list for kidney transplantation, constituted the control group (HD group). Patient survival rate 1, 3 and 5 years following transplantation was better in KP group (93%, 89%, 89%, respectively) than in K group (88%, 88%, 73%, respectively) and in HD group (88%, 62%, 51%, respectively). Kidney graft survival at 1, 3 and 5 years post-transplant was better in KP group (93%, 72%, 72%, respectively) than in K group (76%, 61%, 31%, respectively). 1 year after transplantation, patients of the KP group who had lost the pancreas for technical reasons (thrombosis) were included in the K group so as to evaluate the effect of the transplanted pancreas on long-term patient and kidney survival. Patient survival rate in the KP group (17 patients) at 2 and 4 years was 100%, while at the same intervals it was 78% in the K group (13 patients). Kidney graft function rate at 2 and 4 years was 93% in the KP group (17 grafts) and 54% and 27% respectively in the K group (14 grafts). Evaluation of quality of life in patients receiving a kidney and pancreas transplantation showed an improvement in psychological well-being, when compared to patients receiving a kidney transplantation alone. Physical well-being was similar in patients transplanted with kidney and pancreas or with kidney alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587642
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  • 9
    Electronic Resource
    Electronic Resource
    Pancreas and kidney transplantation: the San Raffaele Hospital (Milan, Italy) experience (1991)
    Springer
    Diabetologia 34 (1991), S. S11 
    Details
    ISSN: 1432-0428
    Keywords: Pancreas transplant ; Surgical complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Results of 33 simultaneous pancreas and kidney transplantations performed at the San Raffaele Hospital, Milan, Italy are presented. In 26 cases segmental neoprene duct-injected grafts were transplanted and in seven cases, duodenopancreatic bladder-drained grafts. Five-year patient, kidney and pancreas survival were respectively, 89%,72% and 58%. Five-year survival in patients with technically successful pancreas transplants was 73%. Thrombosis occured in 20% of cases. Mortality was 6% and overall morbidity 76%. Surgical complications were present in 51% of cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587609
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  • 10
    Electronic Resource
    Electronic Resource
    Amelioration of nerve conduction velocity following simultaneous kidney/pancreas transplantation is due to the glycaemic control provided by the pancreas (1997)
    Springer
    Diabetologia 40 (1997), S. 1110-1112 
    Details
    ISSN: 1432-0428
    Keywords: Keywords IDDM ; diabetic polyneuropathy ; pancreas transplantation ; kidney transplantation ; metabolic control.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diabetic polyneuropathy is a common, disabling chronic complication of diabetes mellitus. Previous studies have suggested that combined pancreas-kidney transplantation can ameliorate nerve conduction. The relative contribution of the correction of hyperglycaemia and uraemia on nerve function is still a matter of debate. Nerve conduction velocity (NCV) was assessed before and after simultaneous pancreas and kidney transplantation, and before and after pancreas graft failure in five insulin-dependent diabetic (IDDM) patients affected by severe diabetic polyneuropathy. Sensory and motor NCV were recorded in five nerves and expressed as a cumulative index for each patient. Metabolic control was evaluated by fasting blood glucose and glycosylated haemoglobin levels. NCV index was below normal values before transplant: –3.8 ± 0.7 (normal value: 0.89), improved 1 and 2 years after transplant: –3.1 ± 1.3 and –2.6 ± 0.9 (p = 0.0019), stabilised until pancreas failure and deteriorated to pre-transplant values 2 years after pancreas graft failure: –3.6 ± 1.0 (p = 0.034). Fasting blood glucose levels worsened after pancreas graft failure. HbA1 c levels, in the normal range during functioning pancreas graft (6.6 ± 0.6 %), deteriorated after its failure (8.0 ± 0.6 %, p = 0.04). Kidney function was preserved. These data support a positive effect of pancreas transplantation per se on NCV in IDDM subjects with diabetic polyneuropathy, thus demonstrating that metabolic control provided by a self-regulated source of insulin not only halts but also ameliorates nerve function, even if polyneuropathy is advanced. [Diabetologia (1997) 40: 1110–1112]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050795
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