PMID- 9108755
OWN - NLM
STAT- MEDLINE
DCOM- 19970515
LR  - 20221207
IS  - 0004-0010 (Print)
IS  - 0004-0010 (Linking)
VI  - 132
IP  - 4
DP  - 1997 Apr
TI  - Peripheral vascular disease after kidney-pancreas transplantation in diabetic 
      patients with end-stage renal disease.
PG  - 358-61; discussion 361-2
AB  - OBJECTIVE: To determine the long-term effect of a functioning pancreas transplant 
      on peripheral vasculopathy. DESIGN: We compared the progression of peripheral 
      vascular disease in 39 recipients of successful kidney-pancreas transplants (KPT) 
      with 65 consecutive diabetic patients who received cadaver kidney transplants 
      alone (KTA) during the same period in a nonrandomized, retrospective control 
      study. The mean duration of follow-up was more than 4 years in both groups. 
      SETTING: Academic subspecialty referral practice. PATIENTS: A consecutive sample 
      of all KPT recipients with more than 6 months of pancreas allograft function 
      performed between May 1, 1988, and April 30, 1995. All patients who received 
      cadaver renal transplants for diabetic nephropathy during the same period and who 
      maintained a functioning renal allograft for more than 6 months were included as 
      controls. INTERVENTION: Kidney-pancreas transplantation. MAIN OUTCOME MEASURE: 
      Progression of peripheral vascular complications (PVC) defined as any midfoot or 
      limb amputation (AMP), any ischemic ulceration requiring treatment (ULCER), and 
      lower-extremity bypass surgery or angioplasty (LEBP). Ulcers leading to 
      amputation were considered as single events (AMP only). RESULTS: Thirty-five 
      (90%) of 39 KPT recipients are insulin-free. The KTA recipients had more 
      atherosclerotic risk factors, including a higher incidence of coronary artery 
      disease (P = .008), higher serum cholesterol levels (P = .03), and higher 
      triglyceride levels (P = .04) than KPT recipients. Peripheral vascular 
      complications before transplantation were comparable (P = .94) between groups. 
      After transplantation, there were 35 new PVC (9 AMP, 11 ulcers, and 15 LEBP) in 
      18 of 39 KPT recipients vs 32 PVC (10 AMP, 8 ulcers, and 14 LEBP) in 20 of 65 KTA 
      recipients (P = .005), indicating that KPT recipients had more PVC than did KTA 
      recipients, despite a functioning pancreas. Seven bypass grafts failed after KPT, 
      resulting in 6 limb amputations. In contrast, only 3 limb amputations were 
      performed in 14 patients undergoing lower-extremity bypass procedures after KTA. 
      CONCLUSIONS: Despite fewer risk factors for peripheral vasculopathy and the 
      presence of insulin independence, KPT recipients had a higher incidence of PVC 
      than a cohort of uremic diabetic patients undergoing KTA during the same period. 
      These data show that a functioning pancreas allograft performed with a renal 
      transplantation not only does not alter the progression of peripheral vascular 
      disease in patients with renal failure secondary to diabetic nephropathy but also 
      may accelerate PVC.
FAU - Morrissey, P E
AU  - Morrissey PE
AD  - Division of Organ Transplantation, Beth Israel-Deaconess Medical Center, Boston, 
      Mass, USA.
FAU - Shaffer, D
AU  - Shaffer D
FAU - Monaco, A P
AU  - Monaco AP
FAU - Conway, P
AU  - Conway P
FAU - Madras, P N
AU  - Madras PN
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Arch Surg
JT  - Archives of surgery (Chicago, Ill. : 1960)
JID - 9716528
SB  - IM
MH  - Adult
MH  - Aged
MH  - Amputation, Surgical/statistics & numerical data
MH  - Case-Control Studies
MH  - Diabetes Mellitus/*surgery
MH  - Diabetes Mellitus, Type 1/complications/*surgery
MH  - Diabetic Nephropathies/*surgery
MH  - Disease Progression
MH  - Female
MH  - Humans
MH  - Kidney Failure, Chronic/etiology/*surgery
MH  - *Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - *Pancreas Transplantation
MH  - Peripheral Vascular Diseases/epidemiology/etiology/*prevention & control/surgery
MH  - Retrospective Studies
EDAT- 1997/04/01 00:00
MHDA- 1997/04/01 00:01
CRDT- 1997/04/01 00:00
PHST- 1997/04/01 00:00 [pubmed]
PHST- 1997/04/01 00:01 [medline]
PHST- 1997/04/01 00:00 [entrez]
AID - 10.1001/archsurg.1997.01430280032004 [doi]
PST - ppublish
SO  - Arch Surg. 1997 Apr;132(4):358-61; discussion 361-2. doi: 
      10.1001/archsurg.1997.01430280032004.