Kidney function after islet transplant alone in type 1 diabetes - Impact of immunosuppressive therapy on progression of diabetic nephropathy
Kidney function after islet transplant alone in type 1 diabetes - Impact of immunosuppressive therapy on progression of diabetic nephropathy
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DOI：
10.2337/dc06-1794
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发表时间：
2007-05-01
期刊：
影响因子：
16.2
通讯作者：
Secchi, Antonio
中科院分区：
文献类型：
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作者：
Maffi, Paola;Caumo, Andrea;Secchi, Antonio
目的：单纯胰岛移植是替代1型糖尿病患者胰腺内分泌功能的一种选择。我们研究的目的是评估埃德蒙顿免疫抑制方案（他克莫司-西罗莫司协会）对肾功能的影响。研究设计和方法-19例1型糖尿病和代谢不稳定的患者接受胰岛移植和免疫抑制治疗根据埃德蒙顿协议。血清肌酐（sCr）、肌酐清除率（CrCl）和24小时尿蛋白排泄量（UPE）在基线和339个患者月的随访期间进行评估。结果-胰岛移植后，我们观察到1）除了两名sCr在胰岛移植后立即升高的患者外，所有患者的sCr都在正常范围内，尽管取消了免疫抑制剂，患者进展为终末期肾病（ESRD）; 2）对于基线值正常的患者，CrCl保持在正常范围内，并降低，2例基线CrCl降低的患者进展为ESRD; 3）4例患者的24小时UPE恶化（>300 mg/24 h）。在进展为终末期肾病的两名患者中，胰岛移植后立即发生24小时UPE恶化。1例患者在18个月时出现24小时UPE恶化，在停用免疫抑制剂后，UPE恢复至正常范围。在另一个病人24小时UPE增加24个月，并保持稳定，而免疫抑制continued.CONCLUSIONS -在1型糖尿病患者接受胰岛移植单独，他克莫司和西罗莫司的协会应仅用于肾功能正常的患者。对于肾功能轻度下降的患者，应考虑免疫抑制治疗的替代方案。
OBJECTIVE - Islet transplantation alone is an alternative for the replacement of pancreatic endocrine function in patients with type 1 diabetes. The aim of our study was to assess the impact of the Edmonton immunosuppressive protocol (tacrolimus-sirolimus association) on kidney function.RESEARCH DESIGN AND METHODS - Nineteen patients with type 1 diabetes and metabolic instability received islet transplantation alone and immunosuppressive therapy according to the Edmonton protocol. Serum creatinine (sCr), creatinine clearance (CrCl), and 24-h urinary protein excretion (UPE) were assessed at baseline and during a follow-up of 339 patient-months.RESULTS - After islet transplantation we observed 1) sCr within the normal range in all but two patients in whom sCr increased immediately after islet transplantation, and despite withdrawal of immunosuppression, patients progressed to end-stage renal disease (ESRD); 2) CrCl remained within the normal range for those patients who had normal baseline values and decreased, progressing to ESRD in two patients with a decreased baseline CrCl; and 3) 24-h UPE worsened (>300 mg/24 h) in four patients. In the two patients who progressed to ESRD, the worsening of 24-h UPE occurred immediately after islet transplantation. In one patient 24-h UPE worsening occurred at 18 months, and, after withdrawal of immunosuppression, it returned to the normal range. In another patient 24-h UPE increased at 24 months and remained stable while immunosuppression was continued.CONCLUSIONS - In type 1 diabetic patients receiving islet transplantation alone, the association of tacrolimus and sirolimus should be used only in patients with normal kidney function. Alternative options for immunosuppressive treatment should be considered for patients with even a mild decrease of kidney function.