The impact of pancreas and kidney transplant on cardiovascular risk factors (analyzed by mode of immunosuppression and exocrine drainage)

Introduction: The aim of this study was to determine the cardiovascular (CV) risk factor response in Irish patients with type 1 diabetes following simultaneous pancreas and kidney transplantation (SPK), analyzing response based on mode of immunosuppression and surgical drainage in a uniquely homogenous population. Methods: A retrospective review of SPKs carried out between 1993 and 2005 in the National Renal and Pancreatic Centre of Ireland was performed. Weight, glycated hemoglobin (HBA1c), lipid profile, and blood pressure (BP) were measured pre- and post-operatively. Results: Fifty-eight SPK patients with functioning grafts were analyzed. Thirty-two were male. Following transplantation, mean HbA1c fell from 8.1 (+/- 1.5) to 5.2 (+/- 0.5)% (p < 0.0001), total cholesterol from 5.2 (+/- 1.2) to 4.5 (+/- 1.0) mmol/L (p = 0.0004), serum triglycerides from 1.5 (+/- 0.6) to 1.1 (+/- 0.6) mmol/L (p < 0.0001), and serum creatinine from 699.3 (+/- 273.4) to 162.5 (+/- 135.8) mmol/L (p < 0.0001). Systolic and diastolic BP fell from 148.5 (+/- 23.3) to 136.9 (+/- 22.4) mmHg (p = 0.02), and 84.8 (+/- 11.7) to 77.8 (+/- 10.4) mmHg (p = 0.003), respectively. Cholesterol reduction was significantly greater in the group that received cyclosporine (n = 29) compared with a tacrolimus and mycophenolic acid mofetil (MMF) combination (1.3 +/- 0.3 vs. 0.2 +/- 0.2 mmol/L, p = 0.003). Choice of exocrine vs. endocrine graft drainage did not affect risk factor response. Conclusion: SPK resulted in significant improvements both in glucose control and other measured CV risk factors.