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Pancreas Transplant Improves Diabetic Nephropathy

Pancreas transplant alone has a variety of lasting beneficial effects in nephropathy in type 1 diabetic patients who retain their own kidneys. Dr. Piero Marchetti of the University of Pisa and colleagues note that although such transplantation is helpful, long-term effects on conditions such as diabetic nephropathy are not well defined.

To investigate, the researchers evaluated 32 type 1 diabetic patients before and 1 year after successful pancreas transplant. Also evaluated were 30 matched control patients who did not undergo transplantation.

Dr. Marchetti’s reported from the results of the study that, “Transplant alone restored sustained normoglycemia without exogenous insulin administration. It also reduced plasma lipid levels and significantly decreased blood pressure levels.
Furthermore, there was a significant decrease in urinary protein excretion. In fact, four microalbuminuric patients and three macroalbuminuric patients became normoalbuminuric. Creatinine clearance was substantially unchanged.

No such changes were seen in patients who did not undergo transplantation.

The researchers call for longer-term studies, but add that "the beneficial effects of pancreas transplantation…on the native kidneys of diabetic patients supports the concept of considering pancreas transplantation alone as a useful therapeutic option."
Summing up, Dr. Marchetti stated that, "restoration of the lost insulin secretory function by the new pancreas determines sustained normalization of glycemia and, as a consequence, improvement of diabetic nephropathy in patients with proteinuria."
Dr. Marchetti added that the 32 transplant patients were part of a cohort of 60 patients. At 4 years, 98.3% of this group has survived and more than 80% are insulin independent. The procedure, he concluded, has led to "very positive results."
Diabetes Care 2005;28:1366-1370.

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