Kidney Function After Islet Transplant Alone in Type 1 Diabetes
Kidney Function After Islet Transplant Alone in Type 1 Diabetes
复制标题
1 型糖尿病单纯胰岛移植后的肾功能
作者：
P. Maffi;F. Bertuzzi;F. de Taddeo;P. Magistretti;R. Nano;P. Fiorina;A. Caumo;P. Pozzi;C. Socci;M. Venturini;A. Del Maschio;A. Secchi
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.
DOI：
10.1097/00132586-199902000-00065
发表时间：
1998-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
P. Fioretto;M. Steffes;D. Sutherland;F. Goetz;M. Mauer
通讯作者：
P. Fioretto;M. Steffes;D. Sutherland;F. Goetz;M. Mauer
影响因子：
120.7
作者：
Hering, BJ;Kandaswamy, R;Sutherland, DER
通讯作者：
Sutherland, DER
DOI：
10.1152/ajprenal.2001.281.4.f693
发表时间：
2001-10-01
影响因子：
4.2
作者：
Lieberthal, W;Fuhro, R;Levine, JS
通讯作者：
Levine, JS