Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients

Paolo Fiorina, Ennio La Rocca, Ettore Astorri, Giovanni Lucignani, Claudio Rossetti, Ferruccio Fazio, Daniela Giudici, Valerio Di Carlo, Marco Cristallo, Guido Pozza, Antonio Secchi

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Abstract

OBJECTIVE - Diastolic function is frequently impaired in diabetic patients. Our aim was to evaluate the effects of glycometabolic control achieved by pancreas transplantation on left ventricular function in uremic type 1 diabetic patients. RESEARCH DESIGN AND METHODS - Left ventricular systolic and diastolic functions were evaluated using radionuclide ventriculography in 42 kidney-pancreas transplant patients and 26 kidney-alone recipients who had similar clinical characteristics before transplantation. Patients were grouped according to 6, 24, and 48 months of follow-up. Control subjects consisted of 20 type 1 diabetic patients. RESULTS - The left ventricular ejection fraction was normal in all of the patients. However, kidney-pancreas transplant patients with 4 years of graft function had a higher ejection fraction (75.7 ± 1.8%) than kidney-alone patients with 4 years of graft function (65.3 ± 2.8%, P = 0.02) and type 1 diabetic patients (61.3 ± 3.7%, P = 0.004). In patients with 4 years of graft function, normal diastolic parameters were evident in kidney-pancreas but not in kidney-alone or in type 1 diabetic patients (peak filling rate: 4.46 ± 0.15 end diastolic volume (EDV)/s in kidney-pancreas patients vs. 2.73 ± 0.24 EDV/s [P <0.01] and 3.39 ± 0.30 EDV/s [P <0.01] in kidney-alone and type 1 diabetic patients, respectively; time-to-peak filling rate: 141.9 ± 7.8 ms in kidney-alone patients vs. 209.4 ± 13.5 ms in kidney-alone patients [P <0.01]; peak filling rate/peak ejection rate ratio: 1.10 ± 0.04 in kidney-pancreas patients vs. 0.81 ± 0.08 in kidneyalone patients [P <0.01]). A significant reduction in diastolic dysfunction rate was observed only in kidney-pancreas patients. CONCLUSIONS - Kidney-pancreas transplantation results in complete insulin independence, a better glycometabolic pattern and blood pressure control, an improvement of left ventricular function, and a reversal of diastolic dysfunction.

Original languageEnglish
Pages (from-to)1804-1810
Number of pages7
JournalDiabetes Care
Volume23
Issue number12
Publication statusPublished - 2000

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Fiorina, P., La Rocca, E., Astorri, E., Lucignani, G., Rossetti, C., Fazio, F., Giudici, D., Di Carlo, V., Cristallo, M., Pozza, G., & Secchi, A. (2000). Reversal of left ventricular diastolic dysfunction after kidney-pancreas transplantation in type 1 diabetic uremic patients. Diabetes Care, 23(12), 1804-1810.