1
|
Lee KW, Sim J, Park SSW, Jeon J, Kim G, Kim MJ, Kwon GY, Jang HR, Huh W, Park JB. Recoverability of Diabetic Nephropathy of Donor Kidney After Kidney Transplantation. Transpl Int 2022; 35:10714. [PMID: 36187463 PMCID: PMC9519853 DOI: 10.3389/ti.2022.10714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022]
Abstract
Some kidney donors have diabetes, and little of their natural course of diabetic nephropathy (DN) is known. The aim of this study was to analyze the changes in pathologic lesions in the diabetic donor kidney after KT by performing protocol biopsy two weeks and one year after KT. This retrospective study included 103 patients who underwent KT, with kidneys from donors with a history of diabetes mellitus (DM). Among them, data of 34 patients who underwent biopsy two weeks and one year after KT were reviewed. Biopsy specimens were reviewed using light microscopy and electron microscopy. Glomerular basement membrane (GBM) thickness at 2 weeks and 1 year was compared. Biopsy showed that DN occurred in 29 of the 34 patients. Only trivial histological changes were observed in 22 patients (64.7%), including 5 patients who did not show DN. At one year after transplantation, there was no change in the DN histologic class in 26 patients (76.5%), and there was no statistically significant difference in the change in GBM thickness. This pattern was observed regardless of the recipient’s DM or glycemic control. With this understanding, clinicians can use kidneys from DM donors with more comfort, thereby reducing the kidney discard rate.
Collapse
Affiliation(s)
- Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jongmin Sim
- Department of Pathology, Anam Hospital, Korea University, Seoul, South Korea
| | - Sean S. W. Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul Medical Center, Seoul, South Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
- *Correspondence: Jae Berm Park,
| |
Collapse
|
2
|
Carmona MD, Paco-Meza LM, Ortega R, Cañadillas S, Caballero-Villarraso J, Blanco A, Herrera C. Hypoxia preconditioning increases the ability of healthy but not diabetic rat-derived adipose stromal/stem cells (ASC) to improve histological lesions of streptozotocin-induced diabetic nephropathy. Pathol Res Pract 2022; 230:153756. [PMID: 35032832 DOI: 10.1016/j.prp.2021.153756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mesenchymal stromal cells (MSC) have demonstrated ability to improve diabetic nephropathy (DN) in experimental models, as well as by improving kidney endogenous progenitor cells proliferation and differentiation. Many studies have demonstrated the effect of hypoxia on MSC improving their functionality but the potential enhancement of the nephroprotective properties of MSC cultured under low oxygen concentration has been explored in few studies, none of them in the context of DN. On the other hand, diabetes is associated with abnormalities in MSCs functionality. These findings related to the hypoxia preconditioning ability to enhance adipose-tissue derived-MSC (ASC) performance have led us to wonder if hypoxia could increase the known beneficial effect of normal ASC in DN and if it could correct the expected inability of diabetic rat-derived ASC to exert this effect in vivo. To answer these questions, in the present study we have used ASC from healthy and diabetic-induced rats, cultured under standard conditions or hypoxia preconditioned, in a DN rat model induced by streptozotocin (STZ). METHODS Diabetes was induced in Wistar-rats by 60 mg/kg streptozotocin (STZ) intraperitoneal injection. Fifteen days thereafter, five diabetic-induced rats and five healthy, previously injected with saline, were sacrificed and used as ASC donors . Both healthy and diabetic rat-derived ASC (cASC and dASC, respectively) were cultured under standard conditions (21%O2)(N) or were subjected to a 48 h conditioning period in hypoxia (3%O2)(H). Thus, four types of cells were generated depending on their origin (healthy or diabetic-induced rats) and the culture conditions(N or H):cASC-N, cASC-H, dASC-N and dASC-H. DN experimental study were carried out fifteen days after STZ induction of diabetes in fifty-two healthy rats. DN-induced-animals were randomly assigned to be injected with 200 µL saline as placebo or with 3 × 106 cASC-N, cASC-H, dASC-N or dASC-H, according to the study group. Serum glucose, urea and creatinine, and urine albumin levels were measured at 2-weeks intervals until day+ 45 after ND-induction.Animals were sacrificed and kidneys extracted for histopathological and transmission electron microcopy analysis RESULTS: None of the four study groups that received cell treatment showed significant changes in serum glucose, urea and creatinine levels, urine albumin concentration and body weight compared to placebo ND-induced group. Interestingly, only the group that received cASC-H showed a reduction in glucose and creatinine levels although it did not reach statistical significance.All DN-induced groups treated with ASC reduced significantly renal lesions such as mesangial expansion, mesangiolysis, microaneurysms and acute tubular necrosis compared to ND-induced placebo group (p ≤ 0.05). Renal injuries such as clear tubular cell changes, thickening of tubular basement membrane, tubular cysts and interstitial fibrosis significantly showed reduction in ND-induced rats treated with cASC-H regarding to their received cASCN (p ≤ 0.05). Non statistical differences were observed in the improvement capacity of cASC and dASC culture under standard condition.However, hypoxia preconditioning reduces the presence of tubular cysts (p ≤ 0.01). CONCLUSIONS Hypoxia preconditioning enhances the ability of healthy rat-derived ASC to improve kidney injury in a rat model of DN. Moreover, diabetic-derived ASC exhibits a similar ability to healthy ASC which is clearly more than expected, but it is not significantly modified by hypoxia preconditioning.
Collapse
Affiliation(s)
- MDolores Carmona
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; Cellular Therapy Unit and Hematology Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; University of Cordoba, Spain.
| | - Luis-Miguel Paco-Meza
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain.
| | - Rosa Ortega
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; Anatomy Pathology Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain.
| | - Sagrario Cañadillas
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain.
| | - Javier Caballero-Villarraso
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; Clinical Analysis Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; University of Cordoba, Spain.
| | - Alfonso Blanco
- Anatomy and Comparative Pathological Anatomy Department, University of Cordoba, Carretera Nacional IV Km. 396, CP 14014 Cordoba, Spain.
| | - Concha Herrera
- Maimonides Institute of Biomedical Research in Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; Cellular Therapy Unit and Hematology Department, Reina Sofia University Hospital, Avenida Menéndez Pidal s/n, CP 14004 Cordoba, Spain; University of Cordoba, Spain.
| |
Collapse
|
3
|
Ali Hammood Keelo RM, Elbe H, Bicer Y, Yigitturk G, Koca O, Karayakali M, Acar D, Altinoz E. Treatment with crocin suppresses diabetic nephropathy progression via modulating TGF-β1 and oxidative stress in an experimental model of pinealectomized diabetic rats. Chem Biol Interact 2022; 351:109733. [PMID: 34743986 DOI: 10.1016/j.cbi.2021.109733] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/27/2021] [Indexed: 11/21/2022]
Abstract
One of the most common complications of diabetes is diabetic nephropathy (DN). Uncontrolled hyperglycemia leads to histopathologic alterations in the kidney that prevent normal renal function. This study aimed to explore the effects of crocin treatment via virtue of its numerous beneficial properties in streptozotocin-induced pinealectomized diabetic rats. The pinealectomy procedure was conducted on the first day of the study. On the 30th day following pinealectomy, streptozotocin (STZ) (50 mg/kg) was administered intraperitoneally in Wistar rats for induction of diabetes. Diabetes was confirmed on the 3rd day following STZ administration by determining the glucose levels. Daily crocin treatment intraperitoneally for 15 days (50 mg/kg) ameliorated impaired renal oxidant/antioxidant balance, reduced TGF-β1 immuno-staining around tubules, and promoted improvement of renal architecture. Moreover, crocin administration improved altered renal function parameters, including serum Cr and BUN, and also increased creatinine clearance. In conclusion, the protective effects of crocin on diabetic nephropathy might be associated with its powerful antioxidant properties, its ability to improve tissue antioxidant status, and its ability to prevent inflammatory pathways.
Collapse
Affiliation(s)
| | - Hulya Elbe
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Yasemin Bicer
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Gurkan Yigitturk
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Oguzhan Koca
- Department of Biochemistry, Karabuk University Education and Research Hospital, Karabuk, Turkey
| | - Melike Karayakali
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey
| | - Derya Acar
- Department of Anatomy, Vocational School of Health Services, Karabuk University, Karabuk, Turkey
| | - Eyup Altinoz
- Department of Medical Biochemistry, Faculty of Medicine, Karabuk University, Karabuk, Turkey.
| |
Collapse
|
4
|
Singh N, Parsons R, Lentine KL, Woodside KJ, Basu A, Cheungpasitporn W, Kensinger C, Parajuli S, Rivera FHC, Sultan S, Tantisattamo E, Zibari G, Pavlakis M, Cooper M. Simultaneous Pancreas-kidney Transplantation for Type 2 Diabetes Mellitus. Transplantation 2021; 105:e91-e92. [PMID: 34291770 DOI: 10.1097/tp.0000000000003752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Neeraj Singh
- John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, LA
| | - Ronald Parsons
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Krista L Lentine
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO
| | - Kenneth J Woodside
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI
| | - Arpita Basu
- Division of Transplantation, Emory University School of Medicine, Atlanta, GA
| | | | | | - Sandesh Parajuli
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Franco H Cabeza Rivera
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS
| | - Samuel Sultan
- Division of Transplantation Surgery, Weill Cornell Medicine and NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Ekamol Tantisattamo
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine School of Medicine, Orange, CA
| | - Gazi Zibari
- John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, LA
| | - Martha Pavlakis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Matthew Cooper
- MedStar Georgetown Transplant Institute (MGTI), Georgetown University School of Medicine, Washington, DC
| |
Collapse
|
5
|
Song CC, Brown A, Winstead R, Yakubu I, Demehin M, Kumar D, Gupta G. Early initiation of sodium-glucose linked transporter inhibitors (SGLT-2i) and associated metabolic and electrolyte outcomes in diabetic kidney transplant recipients. Endocrinol Diabetes Metab 2021; 4:e00185. [PMID: 33855198 PMCID: PMC8029504 DOI: 10.1002/edm2.185] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/12/2020] [Accepted: 08/15/2020] [Indexed: 12/16/2022] Open
Abstract
There is a paucity of data on the use of SGLT2 inhibitors on outcomes in kidney transplant recipients. There may be concern in initiating these agents, especially within the first year post-transplant when renal function is more labile and immunosuppression more intense, due to a presumed high risk of urinary infections and acute kidney injury. This is a retrospective study on 50 kidney transplant recipients, half of whom were started on therapy within the first year of transplant. Over a follow-up period of 6 months, overall patients had a statistically significant improvement in weight by -2.95 kg [SD 3.54, P = <.0001 (CI: 3.53, 1.50)] as well as hypomagnesemia 0.13 [SD 1.73, P = .0004 (CI: 0.06, 0.20)]. Overall insulin usage declined by -3.7 units [SD 22.8, P = .17]. 14% of patients had at least one urinary tract infection although this rate is not different (~20%) than that reported historically in this high-risk population.
Collapse
Affiliation(s)
- Chelsey Chenxi Song
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Andrew Brown
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Ryan Winstead
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Idris Yakubu
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Moses Demehin
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Dhiren Kumar
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| | - Gaurav Gupta
- Hume‐Lee Transplant CenterVirginia Commonwealth University HealthRichmondVAUSA
| |
Collapse
|
6
|
Huang C, Zhou Y, Huang H, Zheng Y, Kong L, Zhang H, Zhang Y, Wang H, Yang M, Xu X, Chen B. Islet Transplantation Reverses Podocyte Injury in Diabetic Nephropathy or Induced by High Glucose via Inhibiting RhoA/ROCK/NF- κB Signaling Pathway. J Diabetes Res 2021; 2021:9570405. [PMID: 33778085 PMCID: PMC7969114 DOI: 10.1155/2021/9570405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Abnormal signaling pathways play a crucial role in the mechanisms of podocyte injury in diabetic nephropathy. They also affect the recovery of podocytes after islet transplantation (IT). However, the specific signaling abnormalities that affect the therapeutic effect of IT on podocytes remains unclear. The purpose of this study was to assess whether the RhoA/ROCK/NF-κB signaling pathway is related to podocyte restoration after IT. METHODS A mouse model of diabetic nephropathy was established in vivo using streptozotocin. The mice were then subsequently reared for 4 weeks after islet transplantation to determine the effect of IT. Islet cells, CCG-1423 (RhoA Inhibitor), and fasudil (ROCK inhibitor) were then cocultured with podocytes in vitro to assess their protective effects on podocyte injury induced by high glucose (HG). Protein expression levels of RhoA, ROCK1, synaptopodin, IL-6, and MCP-1 in kidney tissues were then measured using immunohistochemistry and Western blotting techniques. RESULTS Islet transplantation reduced the expression levels of RhoA/ROCK1 and that of related inflammatory factors such as IL-6 and MCP-1 in the kidney podocytes of diabetic nephropathy. In the same line, islet cells reduced the expression of RhoA, ROCK1, and pp65 in immortalized podocytes under high glucose (35.0 mmol/L glucose) conditions. CONCLUSIONS Islet transplantation can reverse podocyte injury in diabetes nephropathy by inhibiting the RhoA/ROCK1 signaling pathway. Islet cells have a strong protective effect on podocytes treated with high glucose (35.0 mmol/L glucose). Discovery of signaling pathways affecting podocyte recovery is helpful for individualized efficacy evaluation and targeted therapy of islet transplantation patients.
Collapse
Affiliation(s)
- Chongchu Huang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Yi Zhou
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Hongjian Huang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Yushu Zheng
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Lijun Kong
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Hewei Zhang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Yan Zhang
- Transplantation Centre, The First Affiliated Hospital of Wenzhou Medical University, 325015 Wenzhou, Zhejiang Province, China
| | - Hongwei Wang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| | - Mei Yang
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, 325015 Wenzhou, Zhejiang Province, China
| | - Xiaona Xu
- Operating Room, The First Affiliated Hospital of Wenzhou Medical University, 325015 Wenzhou, Zhejiang Province, China
| | - Bicheng Chen
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000 Zhejiang Province, China
| |
Collapse
|
7
|
Pomposelli T, Schuetz C, Wang P, Yamada K. A Strategy to Simultaneously Cure Type 1 Diabetes and Diabetic Nephropathy by Transplant of Composite Islet-Kidney Grafts. Front Endocrinol (Lausanne) 2021; 12:632605. [PMID: 34054721 PMCID: PMC8153710 DOI: 10.3389/fendo.2021.632605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
In recent years islet cell transplant has proven itself to be a viable clinical option for a select group of diabetic patients. Graft loss after transplant however continues to hinder the long-term success of the procedure. Transplanting the islets as a pre-vascularized composite islet-kidney graft has emerged as a relevant solution. Much groundbreaking research has been done utilizing this model in conjunction with strategies aimed towards islet cell survival and prolongation of function in the host. Transplanting the islet cells as a prevascularized graft under the capsule of the donor kidney as a composite islet-kidney graft has been shown to provide long term durable blood glucose control in large animal studies by limiting graft apoptosis as well as providing a physical barrier against the host immune response. While promising, this technique is limited by long term immunosuppression requirements of the host with its well-known adverse sequelae. Research into tolerance inducing strategies of the host to the allogeneic and xenogeneic islet-kidney graft has shown much promise in the avoidance of long-term immunosuppression. In addition, utilizing xenogeneic tissue grafts could provide a near-limitless supply of organs. The islet-kidney model could provide a durable and long-term cure for diabetes. Here we summarize the most recent data, as well as groundbreaking strategies to avoid long term immunosuppression and promote graft acceptance.
Collapse
Affiliation(s)
- Thomas Pomposelli
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Christian Schuetz
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Ping Wang
- Precision Health Program, Michigan State University, East Lansing, MI, United States
- Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Kazuhiko Yamada
- Columbia Center for Translational Immunology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Kazuhiko Yamada,
| |
Collapse
|
8
|
Singh N, Tandukar S, Zibari G, Naseer MS, Amiri HS, Samaniego-Picota MD. Successful simultaneous pancreas and kidney transplant in a patient post-COVID-19 infection. Kidney Int 2020; 98:1615-1616. [PMID: 32946881 PMCID: PMC7491417 DOI: 10.1016/j.kint.2020.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Neeraj Singh
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, Louisiana, USA.
| | - Srijan Tandukar
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, Louisiana, USA
| | - Gazi Zibari
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, Louisiana, USA
| | - Muhammad Saad Naseer
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, Louisiana, USA
| | - Hosein S Amiri
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, Louisiana, USA
| | | |
Collapse
|
9
|
Bhattacharjee D, Vracar S, Round RA, Nightingale PG, Williams JA, Gkoutos GV, Stratton IM, Parker R, Luzio SD, Webber J, Manley SE, Roberts GA, Ghosh S. Utility of HbA 1c assessment in people with diabetes awaiting liver transplantation. Diabet Med 2019; 36:1444-1452. [PMID: 30474191 PMCID: PMC6850030 DOI: 10.1111/dme.13870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
AIMS To investigate the relationship between HbA1c and glucose in people with co-existing liver disease and diabetes awaiting transplant, and in those with diabetes but no liver disease. METHODS HbA1c and random plasma glucose data were collected for 125 people with diabetes without liver disease and for 29 people awaiting liver transplant with diabetes and cirrhosis. Cirrhosis was caused by non-alcoholic fatty liver disease, hepatitis C, alcoholic liver disease, hereditary haemochromatosis, polycystic liver/kidneys, cryptogenic/non-cirrhotic portal hypertension and α-1-antitrypsin-related disease. RESULTS The median (interquartile range) age of the diabetes with cirrhosis group was 55 (49-63) years compared to 60 (50-71) years (P=0.13) in the group without cirrhosis. In the diabetes with cirrhosis group there were 21 men (72%) compared with 86 men (69%) in the group with diabetes and no cirrhosis (P=0.82). Of the group with diabetes and cirrhosis, 27 people (93%) were of white European ethnicity, two (7%) were South Asian and none was of Afro-Caribbean/other ethnicity compared with 94 (75%), 16 (13%), 10 (8%)/5 (4%), respectively, in the group with diabetes and no cirrhosis (P=0.20). Median (interquartile range) HbA1c was 41 (32-56) mmol/mol [5.9 (5.1-7.3)%] vs 61 (52-70) mmol/mol [7.7 (6.9-8.6)%] (P<0.001), respectively, in the diabetes with cirrhosis group vs the diabetes without cirrhosis group. The glucose concentrations were 8.4 (7.0-11.2) mmol/l vs 7.3 (5.2-11.5) mmol/l (P=0.17). HbA1c was depressed by 20 mmol/mol (1.8%; P<0.001) in 28 participants with cirrhosis but elevated by 28 mmol/mol (2.6%) in the participant with α-1-antitrypsin disorder. Those with cirrhosis and depressed HbA1c had fewer larger erythrocytes, and higher red cell distribution width and reticulocyte count. This was reflected in the positive association of glucose with mean cell volume (r=0.39) and haemoglobin level (r=0.49) and the negative association for HbA1c (r=-0.28 and r=-0.26, respectively) in the diabetes group with cirrhosis. CONCLUSION HbA1c is not an appropriate test for blood glucose in people with cirrhosis and diabetes awaiting transplant as it reflects altered erythrocyte presentation.
Collapse
Affiliation(s)
| | - S. Vracar
- Medical SchoolUniversity of BirminghamBirminghamUK
| | - R. A. Round
- Clinical Laboratory ServicesUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - P. G. Nightingale
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - J. A. Williams
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- Mammalian Genetics UnitMedical Research Council Harwell InstituteHarwellUK
| | - G. V. Gkoutos
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
- MRC Health Data Research UK (HDR UK)BirminghamUK
- NIHR Experimental Cancer Medicine CentreBirminghamUK
- NIHR Surgical Reconstruction and Microbiology Research CentreBirminghamUK
- NIHR Biomedical Research CentreBirminghamUK
| | - I. M. Stratton
- Gloucestershire Retinal Research GroupGloucestershire Hospitals NHS Foundation TrustCheltenhamUK
| | - R. Parker
- Leeds Liver UnitSt James's University HospitalLeedsUK
| | - S. D. Luzio
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Research GroupSwansea UniversitySwansea
| | - J. Webber
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - S. E. Manley
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- College of Medical and Dental SciencesInstitute of Metabolism and Systems ResearchUniversity of BirminghamBirmingham
| | - G. A. Roberts
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Diabetes Research GroupSwansea UniversitySwansea
- HRB‐Clinical Research Facility ‐ CorkUniversity College CorkCorkIreland
| | - S. Ghosh
- Diabetes Translational Research GroupDiabetes CentreQueen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
- Institute of Translational MedicineUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK
| |
Collapse
|
10
|
Sharma A, Vas P, Cohen S, Patel T, Thomas S, Fountoulakis N, Karalliedde J. Clinical features and burden of new onset diabetic foot ulcers post simultaneous pancreas kidney transplantation and kidney only transplantation. J Diabetes Complications 2019; 33:662-667. [PMID: 31301954 DOI: 10.1016/j.jdiacomp.2019.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with diabetes and kidney disease are at risk of diabetes-related foot ulcers (DFU). Whether this risk is modified post simultaneous pancreas-kidney (SPK) or kidney only (KO) transplant is unknown. METHODS We evaluated the incidence of new onset DFU post SPK and KO transplant in 235 patients with diabetic kidney disease and diabetic neuropathy. In total 90 (51% male) SPK patients and 145 KO (66% male, 26% Type 1 DM) were evaluated in a single centre retrospective study. Median (range) follow up was 6 (3 to 13) years for both cohorts. RESULTS We observed that 16 (17%) of SPK and 22 (15%) KO patients respectively developed a DFU during follow up. In both cohorts a history of peripheral arterial disease [37.5% vs. 4%] and pre-transplant history of DFU were associated with post transplant DFU (p ≪ 0.05). In KO cohort, patients who developed a DFU were more likely to have T1DM than T2DM (29% vs. 10%), p ≪ 0.05. There was no impact of DFU on SPK transplant failure. In contrast patients with DFU post KO transplant had more than five fold increased hazard ratio (HR) of transplant failure as compared to those without DFU independent of other risk factors [HR 5.19 95% CI (2.05 to 13.18) p = 0.001]. CONCLUSION Nearly 1 in 7 patients develop a new onset DFU post KO or SPK transplantation and DFU also significantly increases risk of failure of the transplanted kidney. Our results highlight the need for greater awareness of regular foot examination, DFU prevention and risk evaluation in post-transplant patients. RESEARCH IN CONTEXT Evidence before this study Patients with diabetes and kidney disease are at enhanced risk of diabetic foot ulcers (DFU). Whether this risk is modified post successful kidney only (KO) or simultaneous pancreas and kidney (SPK) transplantation is unknown. Small case series and studies with short term follow up report varied rates of incidence and are from historical cohorts before the use of modern anti-transplant medications and treatments. Short term studies also suggest that post SPK the resultant normoglycaemia may reverse some features and risk markers of DFU. There are no long term studies on the incidence and impact of diabetic foot ulcers in patients with diabetic kidney disease post SPK or KO transplantation. Added value of this study We report the long term follow up results on DFU incidence, clinical features and related impact on transplant viability in 235 patients with diabetic kidney disease and neuropathy post successful SPK and KO transplant at a single centre. We observed that nearly 1 in 7 patients developed a DFU during follow up and that in patients who received KO transplant onset of DFU was associated with more than 5 fold increase of transplant failure. Implications of all the available evidence Our results highlight the need for greater awareness of regular foot examination, DFU prevention and risk evaluation in post-transplant patients. Despite normoglycaemia post SPK there is a residual burden and risk of DFU. Our work establishes a clinical rationale for further research to explore putative mechanisms that could explain the association between DFU and renal transplant dysfunction.
Collapse
Affiliation(s)
- Angelica Sharma
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK
| | - Prashanth Vas
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK.
| | - Siew Cohen
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK
| | - Tejal Patel
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK
| | - Stephen Thomas
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK
| | - Nikolaos Fountoulakis
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK
| | - Janaka Karalliedde
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK; Department of Renal Medicine, Guy's and St Thomas' NHS Trust, London, UK; Department of Diabetes and Endocrinology, King's College Hospital, London, UK.
| |
Collapse
|
11
|
Harding JL, Pavkov ME, Gregg EW, Burrows NR. Trends of Nontraumatic Lower-Extremity Amputation in End-Stage Renal Disease and Diabetes: United States, 2000-2015. Diabetes Care 2019; 42:1430-1435. [PMID: 31142496 PMCID: PMC11000250 DOI: 10.2337/dc19-0296] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Nontraumatic lower-extremity amputation (NLEA) is a complication of end-stage renal disease (ESRD) and diabetes. Although recent data show that NLEA rates in the U.S. ESRD population are declining overall, trends in diabetes and diabetes subgroups remain unclear. RESEARCH DESIGN AND METHODS We estimated annual rates of NLEA hospitalizations during 2000-2015 among >2 million adults (≥18 years) with ESRD from the U.S. Renal Data System. Age, sex, and race-adjusted NLEA rates were stratified by diabetes status, age, sex, race, and level of amputation (toe, foot, below the knee, and above the knee). Time trends were assessed using Joinpoint regression with annual percent changes (APC) reported. RESULTS Among adults with diabetes, NLEA rates declined 43.8% between 2000 and 2013 (from 7.5 to 4.2 per 100 person-years; APC -4.9, P < 0.001) and then stabilized. Among adults without diabetes, rates of total NLEAs declined 25.5% between 2000 and 2013 (from 1.6 to 1.1; APC -3.0, P < 0.001) and then stabilized. These trends appear to be driven by a slowing or stagnation in declines of minor NLEAs (toe and foot) in more recent years, while major NLEAs (above the knee) continue to decline. CONCLUSIONS Despite an initial period of decline, this analysis documents a stall in progress in NLEA trends in recent years in a high-risk population with both ESRD and diabetes. Increased attention to preventive foot care in the ESRD population should be considered, particularly for those with diabetes.
Collapse
Affiliation(s)
- Jessica L Harding
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nilka R Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
12
|
Tsai SF, Chen CH. Management of Diabetes Mellitus in Normal Renal Function, Renal Dysfunction and Renal Transplant Recipients, Focusing on Glucagon-Like Peptide-1 Agonist: A Review Based upon Current Evidence. Int J Mol Sci 2019; 20:ijms20133152. [PMID: 31261624 PMCID: PMC6651241 DOI: 10.3390/ijms20133152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/23/2019] [Accepted: 06/27/2019] [Indexed: 12/22/2022] Open
Abstract
Diabetes Mellitus (DM) is a leading cause of both Cardiovascular Disease (CVD) and End-stage Renal Disease (ESRD). After 2008, there has been much evidence presented, and recently the guidelines for sugar control have changed to focus on being more disease orientated. GLP-1 Receptor Agonists (GLP-1R) and sodium glucose cotransporter-2 inhibitors are suggested as the first line towards fighting all DM, CVD and ESRD. However, the benefits of GLP-1R in organ transplantation recipients remain very limited. No clinical trials have been designed for this particular population. GLP-1R, a gastrointestinal hormone of the incretin family, possesses antidiabetic, antihypertensive, anti-inflammatory, anti-apoptotic and immunomodulatory actions. There are few drug–drug interactions, with delayed gastric emptying being the major concern. The trough level of tacrolimus may not be significant but should still be closely monitored. There are some reasons which support GLP-1R in recipients seeking glycemic control. Post-transplant DM is due to an impaired β-cell function and glucose-induced glucagon suppression during hyperglycemia, which can be reversed by GLP-1R. GLP-1R infusion tends to relieve immunosuppressant related toxicity. Until now, in some cases, glycemic control and body weight reduction can be anticipated with GLP-1R. Additional renal benefits have also been reported. Side effects of hypoglycemia and gastrointestinal discomfort were rarely reported. In conclusion, GLP-1R could be implemented for recipients while closely monitoring their tacrolimus levels and any potential side effects. Any added benefits, in addition to sugar level control, still require more well-designed studies to prove their existence.
Collapse
Affiliation(s)
- Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Life Science, Tunghai University, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan.
- Department of Life Science, Tunghai University, Taichung 407, Taiwan.
| |
Collapse
|
13
|
Chao AT, Chee Fang S, Lam BC, Cheng AK, Low SK, Su Chi L. Effect of bariatric surgery on diabetic nephropathy in obese type 2 diabetes patients in a retrospective 2-year study: A local pilot. Diab Vasc Dis Res 2018; 15:139-144. [PMID: 29153006 DOI: 10.1177/1479164117742315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To determine the effects of bariatric surgery on albuminuria in obese patients with type 2 diabetes mellitus. METHODS Retrospective analyses of clinical records of obese patients with type 2 diabetes mellitus who had either micro- or macroalbuminuria and had undergone various bariatric surgery were retrieved from a local hospital database. Their clinical data from follow-up appointments including albuminuria were analysed. RESULTS Of the 46 subjects with type 2 diabetes mellitus, 15 subjects had diabetic nephropathy and had pre- and post-bariatric surgery urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio data available for analysis; 13 out of the 15 subjects (86.7%) showed improvement of urine albumin-to-creatinine ratio or urine protein-to-creatinine ratio after surgery; 2 showed equivocal results; 9 of 13 subjects (69.2%) showed remission of diabetic nephropathy; 7 of these 9 patients had microalbuminuria before surgery, 2 had macroalbuminuria before surgery. There were significant improvements to glycosylated haemoglobin, fasting plasma glucose, blood pressure and body weight post surgery. The usage of insulin and oral medications dropped significantly post surgery for all subjects. CONCLUSION This study shows that bariatric surgery significantly improves diabetic nephropathy in obese type 2 diabetes mellitus subjects. The results suggest that in our local type 2 diabetes mellitus patients, it is possible not only to improve metabolic parameters, but also to reverse what may be considered established microvascular complications by means of bariatric surgery.
Collapse
Affiliation(s)
| | - Sum Chee Fang
- 1 Diabetes Centre, Khoo Teck Puat Hospital, Singapore
| | - Benjamin Cc Lam
- 2 Family and Community Medicine Department, Khoo Teck Puat Hospital, Singapore
| | - Anton Ks Cheng
- 3 General Surgery Department, Khoo Teck Puat Hospital, Singapore
| | - Serena Km Low
- 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Lim Su Chi
- 4 Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| |
Collapse
|
14
|
Chen X, Luo J, Wu M, Pan Z, Xie Y, Wang H, Chen B, Zhu H. Study on Association of Pentraxin 3 and Diabetic Nephropathy in a Rat Model. J Diabetes Res 2018; 2018:8968573. [PMID: 29725602 PMCID: PMC5872604 DOI: 10.1155/2018/8968573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/08/2017] [Accepted: 12/24/2017] [Indexed: 01/04/2023] Open
Abstract
Diabetic nephropathy (DN) is a serious microvascular complication of diabetes. Compared with other therapies for diabetic patients, islet transplantation can effectively prevent and reverse diabetes-induced microvascular disease, such as diabetic retinopathy and nephropathy. PTX3 is the only long pentraxin that can be detected in renal tissue. In this study, we investigated the expression of PTX3 when early DN was reversed after islet transplantation. Methods. Diabetes was induced in rats by injecting streptozotocin (STZ). Twelve weeks later, the diabetic rats were divided into 2 groups: the islet transplantation group (IT) and the diabetic nephropathy group (DN). Renal injury, renal function, and the expression of PTX3 in the plasma and the kidneys were assessed with urinalysis, immunohistochemical staining, and Western blot, respectively. Results. The expression of PTX3 in the kidney was significantly decreased in the DN group but increased in the IT group because of the reversal of DN. Conclusions. Our data showed that the level of PTX3 in renal tissue is closely related to renal injury in DN. This may be used to quantify the extent of renal injury in DN, provide a potential early indicator of renal tubular injury in early DN patients, and assess DN clinical progression.
Collapse
Affiliation(s)
- Xuehai Chen
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jiao Luo
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Minmin Wu
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhuo Pan
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yue Xie
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hongwei Wang
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bicheng Chen
- Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hong Zhu
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| |
Collapse
|
15
|
Johal S, Jackson-Spence F, Gillott H, Tahir S, Mytton J, Evison F, Stephenson B, Nath J, Sharif A. Pre-existing diabetes is a risk factor for increased rates of cellular rejection after kidney transplantation: an observational cohort study. Diabet Med 2017; 34:1067-1073. [PMID: 28510327 DOI: 10.1111/dme.13383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/27/2023]
Abstract
AIM To investigate whether people with diabetes have an elevated risk of kidney allograft rejection in a well characterized clinical cohort in the setting of contemporary immunosuppression. METHODS We conducted a retrospective cohort study including all kidney allograft recipients at a single centre between 2007 and 2015, linking clinical, biochemical and histopathological data from electronic patient records. RESULTS Data were analysed for 1140 kidney transplant recipients. The median follow-up was 4.4 years post-transplantation, and 117 of the kidney transplant recipients (10.2%) had diabetes at time of transplantation. Kidney allograft recipients with vs without diabetes were older (53 vs 45 years; P<0.001) and more likely to be non-white (41.0% vs 26.4%; P=0.001). Kidney allograft recipients with vs without diabetes had a higher risk of cellular rejection (19.7% vs 12.4%; P=0.024), but not of antibody-mediated rejection (3.4% vs 3.7%; P=0.564). Graft function and risk of death-censored graft loss were similar in the two groups, but kidney allograft recipients with diabetes had a higher risk of death and overall graft loss than those without diabetes. In a Cox regression model of non-modifiable risk factors at time of transplantation, diabetes was found to be an independent risk factor for cellular rejection (hazard ratio 1.445, 95% CI 1.023-1.945; P=0.042). CONCLUSIONS Kidney allograft recipients with diabetes at transplantation should be counselled regarding their increased risk of cellular rejection but reassured regarding the lack of any adverse impact on short-to-medium term allograft function or survival.
Collapse
Affiliation(s)
- S Johal
- School of Medicine, University of Birmingham, Birmingham, UK
| | | | - H Gillott
- School of Medicine, University of Birmingham, Birmingham, UK
| | - S Tahir
- School of Medicine, University of Birmingham, Birmingham, UK
| | - J Mytton
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - F Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - B Stephenson
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - J Nath
- School of Medicine, University of Birmingham, Birmingham, UK
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - A Sharif
- School of Medicine, University of Birmingham, Birmingham, UK
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
16
|
Abstract
The treatment of patients with diabetes mellitus (DM) presents many challenges to care providers and represents a major proportion of healthcare expenditure worldwide. Successful pancreas transplantation provides durable glycemic control and improves survival for patients with diabetes. Progress in the field has mainly been based on large single center studies and the cumulative analyses of registry data from the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry. This review focuses on the outcomes of pancreas transplantation for patients with and without end stage renal disease. It describes the current state of pancreas transplantation, gaps in knowledge, and future studies needed to enable more patients to benefit from this treatment. A common theme that emerges is the need for multicenter randomized trials in pancreas transplantation to define clearly the efficacy, risks, and long term benefits.
Collapse
Affiliation(s)
- Patrick G Dean
- Division of Transplantation Surgery, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55902, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic and Foundation
| | - Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic and Foundation
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic and Foundation
| | - Mark D Stegall
- Division of Transplantation Surgery, Mayo Clinic and Foundation, 200 First Street SW, Rochester, Minnesota 55902, USA
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic and Foundation
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic and Foundation
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic and Foundation
| |
Collapse
|
17
|
López-de-Andrés A, de Miguel-Yanes JM, Hernández-Barrera V, Méndez-Bailón M, González-Pascual M, de Miguel-Díez J, Salinero-Fort MA, Pérez-Farinós N, Jiménez-Trujillo I, Jiménez-García R. Renal transplant among type 1 and type 2 diabetes patients in Spain: A population-based study from 2002 to 2013. Eur J Intern Med 2017; 37:64-68. [PMID: 27514870 DOI: 10.1016/j.ejim.2016.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/11/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND To describe trends in the rates and short-term outcomes of renal transplants (RTx) among patients with or without diabetes in Spain (2002-2013). METHODS We used national hospital discharge data to select all hospital admissions for RTx. We divided the study period into four three-year periods. Rates were calculated stratified by diabetes status: type 1 diabetes (T1DM), type 2 diabetes (T2DM) and no-diabetes. We analyzed Charlson comorbidity index (CCI), post-transplant infections, in-hospital complications of RTx, rejection, in-hospital mortality and length of hospital stay. FINDINGS We identified 25,542 RTx. Rates of RTx increased significantly in T2DM patients over time (from 9.3 cases/100,000 in 2002/2004 to 13.3 cases/100,000 in 2011/2013), with higher rates among people with T2DM for all time periods. T2DM patients were older and had higher CCI values than T1DM and non-diabetic patients (CCI≥1, 31.4%, 20.4% and 21.5%, respectively; P<0.05). Time trend analyses showed significant increases in infections, RTx-associated complications and rejection for all groups (all P values<0.05). Infection rates were greater in people with T2DM (20.8%) and T1DM (23.5%) than in non-diabetic people (18.7%; P<0.05). Time trend analyses (2002-2013) showed significant decreases in mortality during admission for RTx (OR 0.75, 95% CI 0.68-0.83). Diabetes was not associated with a higher in-hospital mortality (OR: 1.20, 95% CI 0.92-1.55). INTERPRETATION RTx rates were higher and increased over time at a higher rate among T2DM patients. Mortality decreased over time in all groups. Diabetes does not predict mortality during admission for RTx. FUNDING Instituto Salud Carlos III and URJC-Banco Santander.
Collapse
Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n. 28292, Alcorcón, Madrid, Spain.
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, 46, Doctor Esquerdo, 28007 Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n. 28292, Alcorcón, Madrid, Spain.
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Profesor Martín Lagos, s/n. 28040, Madrid, Spain.
| | - Montserrat González-Pascual
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n. 28292, Alcorcón, Madrid, Spain.
| | - Javier de Miguel-Díez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, 46, Doctor Esquerdo, 28007 Madrid, Spain.
| | - Miguel A Salinero-Fort
- Dirección Técnica de Docencia e Investigación, Gerencia Atención Primaria, 24, Espronceda, 28003 Madrid, Spain.
| | - Napoleón Pérez-Farinós
- Health Security Agency Ministry of Health, Social Services and Equality, 56, Alcalá, 28071 Madrid, Spain.
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n. 28292, Alcorcón, Madrid, Spain.
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avenida de Atenas s/n. 28292, Alcorcón, Madrid, Spain.
| |
Collapse
|
18
|
Turner RJ, Eikmans M, Bajema IM, Bruijn JA, Baelde HJ. Stability and Species Specificity of Renal VEGF-A Splicing Patterns in Kidney Disease. PLoS One 2016; 11:e0162166. [PMID: 27598902 PMCID: PMC5012578 DOI: 10.1371/journal.pone.0162166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/08/2016] [Indexed: 12/29/2022] Open
Abstract
Vascular endothelial growth factor A (VEGF-A) is essential for maintaining the glomerular filtration barrier. Absolute renal levels of VEGF-A change in patients with diabetic nephropathy and inflammatory kidney diseases, but whether changes in the renal splicing patterns of VEGF-A play a role remains unclear. In this study, we investigated mRNA splicing patterns of pro-angiogenic isoforms of VEGF-A in glomeruli and whole kidney samples from human patients with kidney disease and from mouse models of kidney disease. Kidney biopsies were obtained from patients with acute rejection following kidney transplantation, patients with diabetic nephropathy, and control subjects. In addition, kidney samples were obtained from mice with lupus nephritis, mice with diabetes mellitus, and control mice. The relative expression of each VEGF-A splice variant was measured using RT-PCR followed by quantitative fragment analysis. The pattern of renal VEGF-A splice variants was unchanged in diabetic nephropathy and lupus nephritis and was stable throughout disease progression in acute transplant rejection and diabetic nephropathy; these results suggest renal VEGF-A splicing stability during kidney disease. The splicing patterns were species-specific; in the control human kidney samples, VEGF-A 121 was the dominant isoform, whereas VEGF-A 164 was the dominant isoform measured in the mouse kidney samples.
Collapse
Affiliation(s)
- R. J. Turner
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - M. Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - I. M. Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - J. A. Bruijn
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - H. J. Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
19
|
Bożek-Pająk D, Ziaja J, Kowalik A, Farnik M, Kolonko A, Kujawa-Szewieczek A, Kamińska D, Kuriata-Kordek M, Król R, Więcek A, Klinger M, Cierpka L. Past Cardiovascular Episodes Deteriorate Quality of Life of Patients With Type 1 Diabetes and End-stage Kidney Disease After Kidney or Simultaneous Pancreas and Kidney Transplantation. Transplant Proc 2016; 48:1667-72. [PMID: 27496468 DOI: 10.1016/j.transproceed.2015.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The beneficial influence of kidney (KTx) or simultaneous pancreas and kidney transplantation (SPK) on quality of life (QOL) in patients with end-stage kidney disease caused by type 1 diabetes mellitus was confirmed in many studies. The aim of this study was to identify factors that influence QOL of patients in long-term follow-up after SPK or KTx. METHODS Twenty-seven SPK and 26 KTx patients with good function of transplanted organs at least 1 year after transplantation were enrolled into the analysis. To estimate QOL of the recipients the Kidney Disease and Quality of Life Short Form was applied. RESULTS Within the whole analyzed group, the necessity of exogenous insulin administration correlated (P < .05) with symptom/problem list (γ = -0.35), effects of kidney disease (-0.38), cognitive function (-0.47), sleep (-0.42), overall health (-0.47), physical functioning (-0.61), role-physical (-0.32), pain (-0.50), general health (-0.32), emotional well-being (-0.31), role-emotional (-0.36), social function (-0.33), energy/fatigue (-0.44), and the SF-12 physical composite (-0.44). History of cardiovascular episode correlated (P < .05) with symptom/problem list (γ = -0.59), effects of kidney disease (-0.46), burden of kidney disease (-0.56), sleep (-0.54), social support (-0.51), physical functioning (-0.55), role-physical (-0.70), pain (-0.60), general health (-0.57), emotional well-being (-0.45), role-emotional (-0.95), social function (-0.58), energy/fatigue (-0.59), SF-12 physical composite (-0.45), and SF-12 mental composite (-0.83). CONCLUSIONS Exogenous insulin administration and history of cardiovascular episode are the most important factors influencing QOL in patients after SPK or KTx, particularly worsening its physical components.
Collapse
Affiliation(s)
- D Bożek-Pająk
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - J Ziaja
- Department of Pulmonology, Medical University of Silesia, Katowice, Poland.
| | - A Kowalik
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - M Farnik
- Department of Pulmonology, Medical University of Silesia, Katowice, Poland
| | - A Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - A Kujawa-Szewieczek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - D Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - M Kuriata-Kordek
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - R Król
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | - A Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - M Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - L Cierpka
- Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
20
|
Lindahl JP, Hartmann A, Aakhus S, Endresen K, Midtvedt K, Holdaas H, Leivestad T, Horneland R, Øyen O, Jenssen T. Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation. Diabetologia 2016; 59:844-52. [PMID: 26713324 DOI: 10.1007/s00125-015-3853-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/14/2015] [Indexed: 01/30/2023]
Abstract
AIMS/HYPOTHESIS Mortality due to cardiovascular disease (CVD), particularly coronary artery disease (CAD), is high in type 1 diabetic patients with end-stage renal disease (ESRD). We aimed to determine whether normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, could improve long-term outcomes compared with living donor kidney-alone (LDK) transplantation. METHODS We studied 486 type 1 diabetic patients with ESRD who underwent a first SPK (n = 256) or LDK (n = 230) transplant between 1983 and 2012 and were followed to the end of 2014. Data were retrieved from the Norwegian Renal Registry and hospital records. Kaplan-Meier plots and multivariate Cox regression, with correction for recipient, donor and transplant factors, were used to examine potential associations between transplant type and all-cause and CVD- and CAD-related mortality. RESULTS Median follow-up time was 7.9 years (interquartile range 4.3, 12.9). The adjusted HR for CVD-related deaths in SPK recipients compared with LDK recipients was 0.63 (95% CI 0.40, 0.99; p = 0.047), while the HRs for all-cause and CAD-related mortality were 0.81 (95% CI 0.57, 1.16; p = 0.25) and 0.63 (95% CI 0.36, 1.12; p = 0.12), respectively. Compared with the LDK group, SPK recipients were younger and received grafts from younger donors. Cardiovascular mortality was higher in patients transplanted between 1983 and 1999 compared with those who received their grafts in subsequent years. CONCLUSIONS/INTERPRETATION In patients with type 1 diabetes and ESRD, SPK transplantation was associated with reduced long-term cardiovascular mortality compared with LDK transplantation.
Collapse
Affiliation(s)
- Jørn P Lindahl
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Anders Hartmann
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Knut Endresen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Hallvard Holdaas
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Torbjørn Leivestad
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Rune Horneland
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Ole Øyen
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Trond Jenssen
- Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
21
|
He Y, Xu Z, Fu H, Chen B, Wang S, Chen B, Zhou M, Cai Y. Combined Microencapsulated Islet Transplantation and Revascularization of Aortorenal Bypass in a Diabetic Nephropathy Rat Model. J Diabetes Res 2016; 2016:9706321. [PMID: 27119088 PMCID: PMC4826923 DOI: 10.1155/2016/9706321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/08/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Revascularization of aortorenal bypass is a preferred technique for renal artery stenosis (RAS) in diabetic nephropathy (DN) patients. Restenosis of graft vessels also should be considered in patients lacking good control of blood glucose. In this study, we explored a combined strategy to prevent the recurrence of RAS in the DN rat model. METHODS A model of DN was established by intraperitoneal injection of streptozotocin. Rats were divided into 4 groups: SR group, MIT group, Com group, and the untreated group. The levels of blood glucose and urine protein were measured, and changes in renal pathology were observed. The expression of monocyte chemoattractant protein-1 (MCP-1) in graft vessels was assessed by immunohistochemical staining. Histopathological staining was performed to assess the pathological changes of glomeruli and tubules. RESULTS The levels of urine protein and the expression of MCP-1 in graft vessels were decreased after islet transplantation. The injury of glomerular basement membrane and podocytes was significantly ameliorated. CONCLUSIONS The combined strategy of revascularization and microencapsulated islet transplantation had multiple protective effects on diabetic nephropathy, including preventing atherosclerosis in the graft vessels and alleviating injury to the glomerular filtration barrier. This combined strategy may be helpful for DN patients with RAS.
Collapse
Affiliation(s)
- Yunqiang He
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ziqiang Xu
- Department of Transplantation, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Hongxing Fu
- School of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bin Chen
- Department of B-Mode Ultrasound, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Silu Wang
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Bicheng Chen
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Mengtao Zhou
- Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- *Mengtao Zhou: and
| | - Yong Cai
- Department of Transplantation, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
- *Yong Cai:
| |
Collapse
|
22
|
Zhong HJ, Yuan Y, Xie WR, Chen MH, He XX. Type 2 Diabetes Mellitus Is Associated with More Serious Small Intestinal Mucosal Injuries. PLoS One 2016; 11:e0162354. [PMID: 27598308 PMCID: PMC5012602 DOI: 10.1371/journal.pone.0162354] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinical and experimental research has revealed that diabetes mellitus (DM) is characterized by intestinal hypomotility, gut microbial dysbiosis, increased gut permeability, microcirculation disorders, circulatory changes, and dysfunction of intestinal stem cells, which may be linked to inflammation of intestinal mucosa. However, the relationship between type 2 DM (T2DM) and macroscopic small intestinal mucosal injuries is still unclear. Therefore, we retrospectively studied capsule endoscopy data to determine the relationship between T2DM and small intestinal mucosal injuries. MATERIALS AND METHODS We compared the records of 38 T2DM patients with those of 152 non-DM patients for small intestinal mucosal injuries. Different types of mucosal injuries and Lewis scores were compared between T2DM and non-DM patients. The relationships between patients with or without different types of diabetic complications and the Lewis score was assessed. Moreover, the relationships between insulin resistance and Lewis score, between HbA1c and Lewis score, were also both assessed. RESULTS The prevalence of a villous edema in subjects with T2DM was significantly higher than in those without DM (P < 0.001), but incidence of ulcers was not different (P = 1.000). With T2DM, the Lewis score was also significantly higher (P = 0.002). In addition, subjects with diabetic nephropathy showed significantly higher Lewis scores than patients without diabetic nephropathy (P = 0.033). In Pearson's correlation tests, the homeostasis model assessment of insulin resistance (HOMA-IR) value was correlated positively with the Lewis score (γ = 0.175, P = 0.015), but no statistical correlation was found between HbA1c level and Lewis score (γ = 0.039, P = 0.697). CONCLUSIONS Subjects with T2DM, especially those with diabetic nephropathy, have higher Lewis scores and more serious small intestinal mucosal lesions.
Collapse
Affiliation(s)
- Hao-Jie Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Yu Yuan
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Wen-Rui Xie
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Mei-Hui Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Xing-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
- * E-mail:
| |
Collapse
|
23
|
Sengupta P, Biswas S, Chowdhury S, Nandi AR. Passenger Lymphocyte Syndrome in a Renal Transplant Recipient. J Assoc Physicians India 2015; 63:86-88. [PMID: 27666916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
New onset anaemia within three months after renal transplantation though not very common sometimes present as diagnostic challenge to the renal physicians. Understanding the etiology is necessary for correct management and avoiding adverse graft outcome. Passenger lymphocyte syndrome (PLS) is a rare entity of immune haemolytic anaemia that sometimes occurs in recipient of minor ABO mismatched renal transplantation. In this case report we present an AB positive renal allograft recipient who received organ from an O positive donor and developed acute haemolytic anaemia and jaundice, 19 days after renal transplantation due to PLS.
Collapse
Affiliation(s)
| | | | | | - Atish Ratan Nandi
- Chief Nephrologist, Dept of Nephrology, MP Birla Medical research Center, BelleVue clinic, Kolkata, West Bengal
| |
Collapse
|
24
|
Health Quality Ontario. Pancreas Islet Transplantation for Patients With Type 1 Diabetes Mellitus: A Clinical Evidence Review. Ont Health Technol Assess Ser 2015; 15:1-84. [PMID: 26644812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus is caused by the autoimmune destruction of pancreatic beta (β) cells, resulting in severe insulin deficiency. Islet transplantation is a β-cell replacement therapeutic option that aims to restore glycemic control in patients with type 1 diabetes. The objective of this study was to determine the clinical effectiveness of islet transplantation in patients with type 1 diabetes, with or without kidney disease. METHODS We conducted a systematic review of the literature on islet transplantation for type 1 diabetes, including relevant health technology assessments, systematic reviews, meta-analyses, and observational studies. We used a two-step process: first, we searched for systematic reviews and health technology assessments; second, we searched primary studies to update the chosen health technology assessment. The Assessment of Multiple Systematic Reviews measurement tool was used to examine the methodological quality of the systematic reviews and health technology assessments. We assessed the quality of the body of evidence and the risk of bias according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. RESULTS Our searched yielded 1,354 citations. One health technology assessment, 11 additional observational studies to update the health technology assessment, one registry report, and four guidelines were included; the observational studies examined islet transplantation alone, islet-after-kidney transplantation, and simultaneous islet-kidney transplantation. In general, low to very low quality of evidence exists for islet transplantation in patients with type 1 diabetes with difficult-to-control blood glucose levels, with or without kidney disease, for these outcomes: health-related quality of life, secondary complications of diabetes, glycemic control, and adverse events. However, high quality of evidence exists for the specific glycemic control outcome of insulin independence compared with intensive insulin therapy. For patients without kidney disease, islet transplantation improves glycemic control and diabetic complications for patients with type 1 diabetes when compared with intensive insulin therapy. However, results for health-related quality of life outcomes were mixed, and adverse events were increased compared with intensive insulin therapy. For patients with type 1 diabetes with kidney disease, islet-after-kidney transplantation or simultaneous islet-kidney transplantation also improved glycemic control and secondary diabetic complications, although the evidence was more limited for this patient group. Compared with intensive insulin therapy, adverse events for islet-after-kidney transplantation or simultaneous islet-kidney transplantation were increased, but were in general less severe than with whole pancreas transplantation. CONCLUSIONS For patients with type 1 diabetes with difficult-to-control blood glucose levels, islet transplantation may be a beneficial β-cell replacement therapy to improve glycemic control and secondary complications of diabetes. However, there is uncertainty in the estimates of effectiveness because of the generally low to very low quality of evidence for all outcomes of interest.
Collapse
|
25
|
Du H, Wang Z, Xu H, Wu Q, Zhan H, Hu S. [The effects of sleeve gastrectomy on renal function in type 2 diabetic rats]. Zhonghua Wai Ke Za Zhi 2015; 53:617-621. [PMID: 26653964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the renal function changes and mechanisms on rats with diabetes through a sleeve gastrectomy operation. METHODS Thirty-six rats were induced diabetes through injection of streptozotocin (STZ), and 30 of these diabetic rats that blood glucose levels at the midrange (blood sugar 17.88-23.65 mmol/L, mean: 20.32 mmol/L) were randomly assigned to the sleeve gastrectomy group, Sham-operation group and control group. The serum creatinine, lipid parameters were measured postoperatively. The 24 h urine volume obtained and urine albumin excretion rate (UAER) was calculated. Serum and urinary creatinine were examined and glomerular filtration rate (GFR) was counted. Kidney sections were stained with periodic acid-Schiff, and then the index of mesangial expansion was determined. The expression of synaptopodin for podocytes was also performed through the immunohistochemical procedure. A one-way ANOVA and t-test were performed to evaluate differences between groups and each other. RESULTS Only one rat of SG group died after operation. The GFR ((8.44 ± 2.10) ml · g⁻¹ · d⁻¹), 24 h UAER ((36.04 ± 11.10) mg/d), plasma lipids level (total cholesterol (1.66 ± 0.23) mmol/L, triglycerides (1.25 ± 0.17) mmol/L), kidney weight ((1.61 ± 0.06) g), the index of mesangial expansion ((6.14 ± 1.50)%) and synaptopodin expression ((20.44 ± 2.99)%) were improved in the SG group compared with the sham-operation group ((15.05 ± 3.01) ml · g⁻¹ · d⁻¹, (57.01 ± 11.34) mg/d, (2.15 ± 0.29) mmol/L, (1.65 ± 0.23) mmol/L, (1.93 ± 0.07) g, (11.32 ± 2.09)%, (10.34 ± 1.43)%) and control group ((14.79 ± 2.38) ml · g⁻¹ · d⁻¹, (62.71 ± 16.46) mg/d, (2.23 ± 0.21) mmol/L, (1.59 ± 0.20) mmol/L, (1.91 ± 0.06) g, (10.82 ± 1.79)%, (11.13 ± 2.43)%) (t = 0.781-5.025, all P < 0.05). CONCLUSION The sleeve gastrectomy procedure can improve the renal function in a diabetes rat model may be through protecting the podocytes function and preventing the mesangial expansion of glomeruli.
Collapse
Affiliation(s)
- Hao Du
- Shandong University School of Medicine, Jinan 250012, China
| | | | | | | | | | | |
Collapse
|
26
|
Gregg L. Empowered to do 'what I want to do' despite diabetic ESRD. Nephrol News Issues 2015; 29:8-12. [PMID: 26454908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
27
|
Abstract
The study aimed to examine the effect of gastric bypass on diabetic nephropathy (DN) in Chinese patients. A retrospective study of 101 samples with DN stages I to IV underwent Roux-en-Y gastric bypass. Anthropometric and biochemical parameters were assessed during a 1-year follow-up. Binary logistic regression analysis was used for predictors and ROC for cutoff points. There was significant reduction of medication for diabetes and hypertension. Overall remission of T2DM was 80.2 %. Preoperative albumin/creatinine ratio (ACR) and serum creatinine (SCr) levels could be predictors for DN remission, and the cutoff points were 126 mg/g cr and 57 μmol/L, respectively. Gastric bypass showed improvement of T2DM and DN. Gastric bypass may be more beneficial for those with lower preoperative ACR and SCr.
Collapse
Affiliation(s)
- Hongwei Zhang
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Jianzhong Di
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Haoyong Yu
- />Department of Endocrinology and Metabolism, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Xiaodong Han
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Kun Li
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Pin Zhang
- />Department of General Surgery, The Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233 China
| |
Collapse
|
28
|
Miras AD, Chuah LL, Khalil N, Nicotra A, Vusirikala A, Baqai N, Graham C, Ravindra S, Lascaratos G, Oliver N, le Roux CW. Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case-control study. Diabetologia 2015; 58:1443-7. [PMID: 25893730 PMCID: PMC4473013 DOI: 10.1007/s00125-015-3595-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/17/2015] [Indexed: 12/02/2022]
Abstract
AIMS/HYPOTHESIS We aimed to examine the effects of bariatric surgery on microvascular complications in patients with type 2 diabetes using objective measures. METHODS Prospective case-control study of 70 obese surgical patients with type 2 diabetes undergoing gastric bypass surgery matched for age, sex and duration of diabetes to 25 medical patients treated using international guidelines. Microvascular complications were assessed before and 12-18 months after intervention using urine albumin creatinine ratio (ACR) measurements, two-field digital retinal images and peripheral nerve conduction studies (in the surgical group only). RESULTS Urine ACR decreased significantly in the surgical group but increased in the medical group. There were no significant differences between the surgical and medical groups in the changes in retinopathy. There were no changes in the nerve conduction variables in the surgical group. CONCLUSIONS/INTERPRETATION In the short term, bariatric surgery may be superior to medical care in the treatment of diabetic nephropathy, but not retinopathy or neuropathy.
Collapse
Affiliation(s)
- Alexander D. Miras
- Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
| | - Ling Ling Chuah
- Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
| | - Nofal Khalil
- Department of Clinical Neurophysiology, West London Neurosciences Centre, Charing Cross Hospital, London, UK
| | - Alessia Nicotra
- Department of Clinical Neurophysiology, West London Neurosciences Centre, Charing Cross Hospital, London, UK
| | | | - Najah Baqai
- Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Gerassimos Lascaratos
- Department of Ophthalmology, Guy’s and St Thomas’ Hospitals Foundation Trust, London, UK
| | - Nick Oliver
- Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
| | - Carel W. le Roux
- Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, London, UK
- Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
29
|
Saudek F, Girman P, Lipár K, Bouček P, Kožnarová R, Kočík M. [Pancreas transplantation: State of the art and future prospects]. Vnitr Lek 2015; 61:731-737. [PMID: 26375705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
During the past 30 years pancreas transplantation evolved into a routine procedure especially suitable for type 1 diabetic recipients undergoing simultaneously kidney transplantation significantly improving quality of life and life expectancy as compared with kidney only recipients. It provides insulin independence with near-normal glucose control without special dietary restriction, freedom from hypoglycemia and chance for halting or regression of microangiopathic diabetes complications. As a separate procedure, pancreas transplantation is carried out mainly in selected subjects suffering from severe hypoglycemic episodes and impaired hypoglycemia awareness or as a subsequent procedure in type 1 diabetic kidney recipients from both cadaveric or living donors. Five-year insulin independence rate following combined pancreas and kidney, pancreas only and pancreas after kidney procedures currently exceed 75, 50 and 62 %, respectively. Though the outcomes still continue to improve, the rate of pancreas transplants has reached a plateau in several European countries or even declines in the United States. Main reasons for that include fewer referrals from diabetes specialist, decreased donor quality, introduction of islet transplantation as a less invasive procedure but probably most of all probably insufficient information on the latest progress and trends achieved in this area. In the area of transplant therapy of diabetes Czech Republic traditionally ranks to the most active countries providing different transplant options according to individual clinical needs including islet transplantation.
Collapse
|
30
|
Cortesini R, Marinucci G, Renna Molajoni E, Cinti P, Capua A, Berloco P, Famulari A, Pretagostini R, Rossi M, Alfani D. Immunosuppressive therapy in high-risk patients. Contrib Nephrol 2015; 51:68-72. [PMID: 3552423 DOI: 10.1159/000413098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
31
|
Affiliation(s)
- B Grabensee
- Zentrum für Innere Medizin und Neurologie, Universität Düsseldorf, BRD
| | | |
Collapse
|
32
|
Najarian JS, Sutherland DE. Transplantation in diabetic patients. Contrib Nephrol 2015; 70:56-63. [PMID: 2670440 DOI: 10.1159/000416903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J S Najarian
- Department of Surgery, University of Minnesota Hospital, Minneapolis
| | | |
Collapse
|
33
|
Affiliation(s)
- U Frei
- Abteilung Nephrologie, Medizinische Hochschule Hannover, BRD
| | | | | |
Collapse
|
34
|
Alfani D, Trovati A, Renna Molajoni E, Cinti P, Berloco P, Famulari A, Iappelli M, Rossi M, Pretagostini R, Cortesini R. Clinical experience with ciclosporin at the Rome University Hospital. Contrib Nephrol 2015; 51:64-7. [PMID: 3552422 DOI: 10.1159/000413097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
35
|
Lee YF, Lin CC, Cheng JS, Chen GS. High-intensity focused ultrasound attenuates neural responses of sciatic nerves isolated from normal or neuropathic rats. Ultrasound Med Biol 2015; 41:132-142. [PMID: 25438842 DOI: 10.1016/j.ultrasmedbio.2014.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 06/04/2023]
Abstract
Patients with diabetic neuropathy often have neuropathic pain. The purpose of our work was to investigate the effects of high-intensity focused ultrasound (HIFU) on the conduction block of normal and neuropathic nerves for soothing pain. Adult male Sprague-Dawley rats were used, and diabetes was induced by streptozotocin injection. Diabetic neuropathy was evaluated with animal behavior tests. Sciatic nerves of both control and neuropathic rats were dissected from the starting point of the sciatic nerve to the point where the sural nerve ends near the ankle. The nerves were stored in Ringer's solution. The in vitro nerve was placed on a self-developed experimental platform for HIFU exposure. Stimulation and recording of the compound action potentials (CAPs) and sensory action potentials (SAPs) were performed. Control and neuropathic nerves exposed or not exposed to HIFU were submitted to histologic analysis. For the control and neuropathic nerves, suppression of CAPs and SAPs started 2 min post-HIFU treatment. Maximum suppression of SAPs was 34.4 ± 3.2% for the control rats and 11.6 ± 2.0% and 9.8 ± 3.0% for rats 4 wk post-injection and 8 wk post-injection, respectively. Time to full recovery was 25, 70 and 80 min, respectively. Histologic analysis revealed that the nerves in which CAPs and SAPs did not fully recover were damaged thermally or mechanically by HIFU. It is feasible to reversibly block nerves with appropriate HIFU treatment. Diabetic nerves were less suppressed by HIFU and were more vulnerable to permanent damage.
Collapse
Affiliation(s)
- Yee-Fun Lee
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chou-Ching Lin
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jung-Sung Cheng
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Gin-Shin Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan.
| |
Collapse
|
36
|
Abstract
Diabetes mellitus is a chronic disease that in the long-term increases the microvascular and macrovascular degenerative complications thus being responsible for a large part of death associated with diabetes. During the years, while preventive care for diabetic patients has improved, the increase in the prevalence of diabetes worldwide is continuous. The detrimental effects of diabetes mellitus result in microvascular diseases, which recognize hyperglycemia as major determinant. A significant number of potential therapeutic targets for the treatment of diabetic microvascular complications have been proposed, but the encouraging results obtained in preclinical studies, have largely failed in clinical trials. Currently, the most successful strategy to prevent microvascular complications of diabetes is the intensive treatment of hyperglycemia or the normalization of glycometabolic control achieved with pancreatic and islet transplantation. In this review, we focus on the novel therapeutic targets to prevent the development and progression of diabetic nephropathy and retinopathy microvascular complications.
Collapse
Affiliation(s)
- Vera Usuelli
- Division of Transplant Medicine, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ennio La Rocca
- Division of Transplant Medicine, IRCCS Ospedale San Raffaele, Milan, Italy.
| |
Collapse
|
37
|
Nakhjavani M, Ghaemi F, Ravaghi H, Aghighi M, Ghaemi F. Short-term survival in renal transplantation from brain-death donors: focusing on recipients with diabetes background. Urol J 2014; 11:1474-1477. [PMID: 24807763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/14/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE Our aim was to evaluate short term survival rates in renal transplant recipients from deceased donors, while focusing on recipients with diabetes mellitus background. MATERIALS AND METHODS This is a longitudinal follow-up study based on national registry of recipients in Ministry of Health and Medical Education in Iran from 2010-11. Five hundred fifty-five recipients, 226 (40.8%) females and 328 (59.2%) males, were included in the study. Mean (± SD) age of the recipients was 39 ± 14 years. Of donors 18.4% were females and 81.6% were males. Age of the donors was 33 ± 14 years. All allograft recipients from deceased donors enrolled in the study. Short-term graft survival (1 year) was determined. Data regarding age, gender, background disease and cold ischemic time of recipients and donors were collected from the organ procurement units. RESULTS Allografts were functioning in 499 (90.1%) of recipients after one year. Of recipients 38 (6.9%) died and rejection of transplanted kidney occurred in 17 (3.1%) cases. So, in 55 (9.9%) cases, allografts were not functioning. There were significant relationships between short term graft survival of donors' gender, age of recipients, cold ischemic time and level of clearance of creatinine of recipients. CONCLUSION In addition to cold ischemic time, graft survival can be affected by recipients' age. There are some other considerations and implications regarding the short term graft survival in renal transplantation from cadaver donors which are discussed in this paper.
Collapse
Affiliation(s)
- Manoochehr Nakhjavani
- Department of Endoctrinology, Tehran University of Medical Sciences, Vali'asr Hospital, Tehran, Iran
| | - Fatemeh Ghaemi
- Ministry of Health and Medical Education, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamid Ravaghi
- Department of Health Services Management, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Science, Tehran, Iran
| | - Mohammad Aghighi
- Management Center of Transplantation and Special Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Ghaemi
- Department of Microbiology, Islamic Azad University, Kerman Branch, Kerman, Iran
| |
Collapse
|
38
|
Sakakibara S, Hirade R, Mihara T, Ota J, Nikai T, Saito Y. [Recipient of living kidney transplantation during which heparin-induced thrombocytopenia (HIT) was suspected: a case report]. Masui 2014; 63:346-349. [PMID: 24724449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 67-year-old woman with a diabetic renal failure was scheduled for a living kidney transplantation. Heparin was first used during hemodialysis 5 days before operation. Thrombocytopenia was found immediately after induction of general anesthesia, and the diagnosis of HIT was wade based on clinical symptom and 4 T's scoring. The surgery was continued because of the progress of donor surgery. Argatoroban was administered based on APTT measurement as an anticoagulation therapy during and after the operation. Although deep vein thrombosis was found 13 days after the operation, the transplanted kidney was established successfully. It is necessary to take a great caution in HIT development after heparin use.
Collapse
|
39
|
Zhiqing W, Jing W, Haili X, Shaozhuang L, Chunxiao H, Haifeng H, Hui W, Sanyuan H. Renal function is ameliorated in a diabetic nephropathy rat model through a duodenal-jejunal bypass. Diabetes Res Clin Pract 2014; 103:26-34. [PMID: 24398318 DOI: 10.1016/j.diabres.2013.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/29/2013] [Indexed: 11/25/2022]
Abstract
AIMS Diabetes surgery is growing in popularity and has been shown to have marked effects on diabetes. However, several studies have shown it may induce some renal injury, and, currently, the impact of diabetes surgery on renal function is unclear. In this study, we examined renal function and histological changes in rats with diabetic nephropathy (DN) following a duodeno-jejunal bypass (DJB) operation. METHODS Rats with streptozotocin (STZ)-induced diabetes were randomly assigned to 3 groups: DJB group (DJB), Sham-DJB group (S-DJB) and diabetes group (DM). Six age-matched normal rats were assigned as the control group. DJB and sham surgery were performed. Body weight, food intake, glucose levels, lipid parameters, cystatin C (Cys_C) levels, serum and urinary creatinine, 24h urine albumin excretion rate (UAER) and glomerular filtration rate (GFR) were measured. Histological analysis and immunohistochemical studies of renal sections were also performed. RESULTS DJB ameliorated renal function by improving UAER, GFR and Cys_C levels 4 and 8 weeks after surgery. It also improved lipid metabolism by decreasing fasting total serum cholesterol (TC) and triglyceride (TG) levels. Immuno-staining of synaptopodin showed podocyte injury was also improved in DJB glomeruli compared with sham and DM groups. Histological analysis showed that the mesangial expansion was not significantly prevented 8 weeks after DJB surgery. CONCLUSION DJB ameliorated renal function in UAER and GFR but not mesangial expansion in a DN rat model. The improvement of renal function may be attributed to reversing the injury or loss of podocytes after DJB surgery.
Collapse
Affiliation(s)
- Wang Zhiqing
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China; Department of General Surgery, The Fourth Hospital of Jinan, Shandong, China
| | - Wang Jing
- Department of Pathology, The Fourth Hospital of Jinan, Shandong, China
| | - Xu Haili
- Department of Internal Medicine, Jinan Municipal Hospital of Traditional Chinese Medicine, Shandong, China
| | - Liu Shaozhuang
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Hu Chunxiao
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Han Haifeng
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Wang Hui
- Department of General Surgery, The Fourth Hospital of Jinan, Shandong, China
| | - Hu Sanyuan
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China.
| |
Collapse
|
40
|
Zhou Z, Pan C. [Surgical strategy for management of postoperative stenosis of ateriovenous fistula in patients with end-stage renal disease]. Nan Fang Yi Ke Da Xue Xue Bao 2013; 33:1538-1540. [PMID: 24144764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the surgical approaches for management of postoperative stenosis of ateriovenous fistula (AVF) in patients with end-stage renal disease (ESRD). METHODS Of the 415 patients with ESRD receiving radial-cephalic end-to-side anastomosis during the last 3 years, 29 developed postoperative AVF stenosis (of type Ia in 5 cases, type Ib in 17 cases, type II in 3 cases, and type II in 2 cases). A proximal anastomosis was created between the radical artery and cephalic vein for type Ia stenosis. In the 17 cases with type I b stenosis, 5 were managed by interception of suitable segments from the accessory cephalic veins for cephalic vein reconstructions, and 12 by transposition of the accessory cephalic veins. Of 3 cases with type II stenosis, 1 was managed by interception of the accessory cephalic vein for interposing into the cephalic vein, 1 by interception of the distal great saphenous vein for interposing into the cephalic vein, and 1 by transposition of the forearm basilic vein for end-to-side anastomosis with the radial artery. The 2 cases with type III were managed by end-to-side anastomosis between the forearm basilic vein and the radial artery or by conversion to AVF repair on the contralateral forearm. RESULTS Twenty-eight of the 28 patients finally received surgical repair of AVF stenosis and the surgeries were completed successfully. Thrombosis of the outflow vein occurred 12 h after the repair in 1 case to require emergency embolectomy and anastomosis; restenosis occurred in 2 cases at 9 months postoperatively, for which progressive percutaneous transluminal angioplasty (PTA) was performed. The rate of restenosis was 7.1% (2/28). All the 28 patients undergoing AVF stenosis repair had successful HD for 12 months after the operation. CONCLUSION Reconstructing the arteriovenous anastomosis, replacing the stenosis segment with an accessory cephalic vein or great saphenous vein graft, or altering the outflow with the forearm basilic vein can be surgical options for repairing postoperative AVF stenosis.
Collapse
Affiliation(s)
- Zhongxin Zhou
- Department of Vascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
| | | |
Collapse
|
41
|
Kirsch T, Krech S, Krech T, Becker JU, Beese M, Gwinner W, Haller H, Meier M. PRKC-isoform mRNA expression in human kidney transplant protocol biopsies: is there a high-glucose-induced regulation in the diabetic state? Acta Diabetol 2013; 50:655-6. [PMID: 22706690 DOI: 10.1007/s00592-012-0408-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/25/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Torsten Kirsch
- Department of Nephrology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Solid organ transplantations save lives in patients affected by terminal organ failures and improve quality of life. Organ transplantations have gradually ameliorated in the last two decades and usually provide excellent results in children and young adults, and are increasingly challenged by the growing proportion of elderly transplant patients with comorbidities. Renal transplantation increases patient survival over dialysis, and lifesaving transplants are indispensible to treat patients with liver, heart, or lung irreversible diseases. Solid organ transplant programs activity has been steadily growing but is still far from global needs, with great differences among countries. Solid organ transplantations are essential for developed and mature health care systems.
Collapse
Affiliation(s)
- Josep M Grinyó
- Department of Nephrology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona 08907, Spain.
| |
Collapse
|
43
|
|
44
|
Hermayer KL, Egidi MF, Finch NJ, Baliga P, Lin A, Kettinger L, Biggins S, Carter RE. A randomized controlled trial to evaluate the effect of glycemic control on renal transplantation outcomes. J Clin Endocrinol Metab 2012; 97:4399-406. [PMID: 23074234 DOI: 10.1210/jc.2012-1979] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Outcomes from intensive glycemic control postrenal transplant have not been studied. OBJECTIVE Our objective was to observe the optimal management of hyperglycemia in patients with diabetes or impaired glucose tolerance receiving renal transplantation. DESIGN, SETTING, AND PATIENTS We conducted a randomized controlled trial with patients undergoing renal transplantation randomized to either i.v. insulin therapy (intensive) or standard s.c. insulin therapy while the patients were admitted to the hospital. INTERVENTIONS The study consisted of a 3-day postrenal transplant group treated with intensive i.v. insulin [blood glucose (BG) = 70-110 mg/dl] or a control group treated with s.c. insulin (BG = 70-180 mg/dl). MAIN OUTCOME MEASURE The primary endpoint was delayed graft function (DGF). Secondary endpoints were glycemic control, graft survival, and acute rejection episodes. RESULTS A total of 104 patients were screened and randomized to either the intensive or control condition; however, the intention-to-treat analysis set consisted of only the 93 participants (n = 44 intensive, n = 49 control) that underwent a renal transplant. DGF was present in 18% (eight of 44) of the intensive group and 24% (12 of 49) of the control group (P = 0.46). The occurrence of severe hypoglycemia (BG < 40 mg/dl) and severe hyperglycemia (BG > 350 mg/dl) were the primary safety outcome measures. There were nine participants with hypoglycemia identified, seven of which (78%) were in the intensive treatment group (P = 0.08). There were 30 instances of hyperglycemia with five participants (11%) in the intensive group and 12 participants (24%) in the control group having at least one hyperglycemic event (P = 0.10). For the 11 rejection episodes, nine were in the intensive treatment group (P = 0.013). CONCLUSIONS The primary outcome measure of DGF was not statistically different for the two treatment groups. Regarding longer-term rejection and graft survival, the intensively treated participants were at higher risk for a rejection episode.
Collapse
Affiliation(s)
- Kathie L Hermayer
- Division of Endocrinology, Diabetes, Medical Genetics, 816 CSB, 96 Jonathan Lucas Street, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Fouzas I, Antoniadis N, Giakoustidis D, Tatsou N, Mouloudi E, Karapanagiotou A, Sklavos A, Tsitlakidis A, Karakatsanis A, Myserlis G, Solonaki F, Daoudaki M, Petridis A, Papagiannis A, Gakis D, Imvrios G, Papanikolaou V. Simultaneous pancreas-kidney transplantation: initial results from a center in Greece. Transplant Proc 2012; 44:2712-4. [PMID: 23146501 DOI: 10.1016/j.transproceed.2012.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The outcome of simultaneous pancreas-kidney transplantation (SPK) in type 1 diabetes has dramatically improved in recent years. We report the initial results of our SPK program. PATIENTS AND METHODS From 2008 to 2010, we performed and prospectively obtained data on 4 SPKs in 4 type 1 diabetic patients with chronic renal failure. The recipients were 3 men and 1 woman, of overall mean age of 40.75 ± 4.78 years, mean time from diabetes diagnosis of 27 ± 15 years, and time on dialysis of 3.5 ± 0.57 years. All grafts were procured from multiorgan brain-dead donors of mean age 26 ± 8.16 years and mean body weight of 74 ± 4.34 kg. The pancreatic grafts were transplanted first into the right iliac fossa with mean cold ischemia times of 10.62 ± 3.09 hours for the pancreatic and 14.00 ± 2.97 hours for the renal grafts. Pancreas arterial inflow was re-established by an end-to-side anastomosis of an extension Y-graft to the recipient right iliac artery. The portal vein was sutured to the iliac vein directly. The exocrine secretions of the pancreas were managed by duodenojejunostomy extraperitoneally (n = 3) or intraperitoneally (n = 1). The ureteral anastomosis was performed using the Taguchi technique. RESULTS After SPK, endocrine pancreatic function was immediately restored in all patients. Insulin administration was stopped within the first 24 hours after surgery. Two patients displayed delayed renal graft function necessitating dialysis for 9 and 23 days, respectively. The postoperative course was prolonged with a mean hospital stay of 82 ± 1 day. At a 31.75 ± 9.03 months follow up all patients are alive with functioning grafts. CONCLUSION Our experience with SPK, although limited, has shown encouraging results over a short follow-up period.
Collapse
Affiliation(s)
- I Fouzas
- Division of Transplantation, Department of Surgery, Aristotle University Medical School, Hippokration General Hospital, Thessaloniki, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Kirkman D, Junglee N, Mullins P, Macdonald JH. Arteriovenous fistula complication following MRI. BMJ Case Rep 2012; 2012:bcr0320126103. [PMID: 22927271 PMCID: PMC4542674 DOI: 10.1136/bcr-03-2012-6103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Health professionals should be aware of medical procedures that cause vascular access complications. This case describes a haemodialysis patient who experienced pain, swelling and bruising over a radiocephalic fistula following MRI. Exactly the same signs and symptoms were evident following a second scan performed 3 months later. Plausible explanations include a radio frequency-induced electrical current being formed at the arteriovenous fistula, or varying gradients of the MRI sequence stimulating peripheral nerves, leading to a site of increased tissue stimulation. Of note, a juxta-anastomotic venous stenosis was confirmed by fistulogram 4 days after the second scan, although whether this access failure was due to the MRI scan per se could not be ascertained. Nevertheless, these previously undocumented observations suggest that careful patient and fistula monitoring is required when completing MRI scans in those with an arteriovenous fistula.
Collapse
Affiliation(s)
- Danielle Kirkman
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Gwynedd, UK
| | - Naushad Junglee
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Gwynedd, UK
- Renal Unit, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Paul Mullins
- Bangor Imaging Centre, School of Psychology, Bangor University, Bangor, Gwynedd, UK
| | - Jamie Hugo Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Gwynedd, UK
| |
Collapse
|
47
|
Alavian SM, Taheri S. Inauspicious contribution of hepatitis C virus and diabetes mellitus targeting kidneys: an update. Iran J Kidney Dis 2012; 6:236-254. [PMID: 22797092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 04/17/2012] [Indexed: 06/01/2023]
Abstract
Hepatitis C virus (HCV) infection and diabetes mellitus are frequent problems worldwide that induce high health and financial burden in different societies, both of which are also highly prevalent in patients with chronic kidney disease. Diabetes mellitus is a known underlying cause of end-stage renal disease, and on the other hand, HCV is responsible for a wide variety of renal manifestations, such as membranous nephropathy, cryoglobulinemia, and membranoproliferative glomerulonephritis. Moreover, along with its direct impact on kidney damage, HCV is also known to play a role in progression of other causes of kidney diseases. It is known that HCV infection is highly prevalent among patients with diabetic nephropathy. This article reviews the existing literature on the relationship between HCV infection and diabetes mellitus in patients with chronic kidney disease, and also overviews the interplay of these two factors in the transplantation era.
Collapse
Affiliation(s)
- Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences and Rezvan Medical Research Center, Tehran, Iran.
| | | |
Collapse
|
48
|
Pavan M, Ranganath R, Chaudhari AP. Early recurrence of diabetic nodular sclerosis in a kidney transplant recipient. Iran J Kidney Dis 2012; 6:219-221. [PMID: 22555488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 09/08/2011] [Indexed: 05/31/2023]
Abstract
Almost all kidney transplant recipients with diabetes mellitus will eventually develop recurrence of diabetic nephropathy in their allograft. Despite this high incidence, there are very few reported cases of diabetic nephropathy of diffuse type, and the nodular sclerosis form is uncommon. Recurrence of diabetic nephropathy of nodular glomerulosclerosis type usually occurs during the second decade of transplantation. We report a rare case of diabetic nodular glomerulosclerosis developing 5 years after transplantation, leading to progressive kidney dysfunction and graft loss.
Collapse
Affiliation(s)
- Malleshappa Pavan
- Department of Nephrology, Vaatsalya Hospital, Bharathi Healthcare Complex, Hassan, Karnataka, India.
| | | | | |
Collapse
|
49
|
Monaghan-Rourke J. Transitioning from peritoneal dialysis to renal transplant: a diabetes management case study. Nephrol Nurs J 2012; 39:141-143. [PMID: 22690448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Renal transplantation represents a challenge for diabetes management both for controlling blood glucose values while on intravenous steroids and for transitioning the patient to a new outpatient insulin regimen. M.B. is adjusting to a "new normal" with a functioning kidney and increased insulin requirements. A renal/diabetes care provider can have a significant impact on the recovery of patients after transplantation by spending additional time listening to patients' concerns, educating them on strategies to effectively manage hyperglycemia while avoiding hypoglycemia and building trust in the healthcare team and treatment plan.
Collapse
|
50
|
Zhu D, Everly MJ. Deceased donor kidney transplantation in the United States from 1988 to 2011: an analysis of the OPTN/UNOS registry. Clin Transpl 2012:1-12. [PMID: 23721006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In the United States, over 170,000 first solitary deceased donor kidney transplants were reported to the United Network of Organ Sharing registry from 1988 to 2011. The composition of transplant recipients has changed over time. There were notable increases in older patients (31% to 64.5%), non-Caucasian patients (36% to 58%), obese patients (body mass index over 35: 11% to 37%), type II diabetes patients (1% to 28%), and patients with hypertension (17% to 31%). Death with functioning graft was a very important factor in analyzing kidney graft survival. The death-censored graft survival rate could more accurately reflect the relationships between risk factors and survival of kidney grafts. Younger patients, especially those younger than 35, had worse graft survival. Patients with diabetes as the primary disease showed poor graft survival, but the effect was not obvious compared to the majority of other primary diseases. Diabetes, either type I or type II, was a main contributor to patient death. There was notable progress in short-term graft survival over time. Long-term graft survival is still a problem. However, 5-year death-censored graft survival in patients who have survived longer than 1 year has improved by 7.9% from 1993 to today. Delayed graft function could impact both short- and long-term graft survival. Human leukocyte antigen compatibility was a main factor of graft survival. Zero mismatch patients have an 18% better 20-year death-censored graft survival than those with 6 antigen mismatches. Panel reactive antibody (PRA) is also an important factor to graft survival. PRA class I and class II has been reported to UNOS since 2004. PRA class II was slightly more related to graft survival compared to PRA class I.
Collapse
Affiliation(s)
- Dong Zhu
- Terasaki Foundation Laboratory, Los Angeles, California, USA.
| | | |
Collapse
|