Patient Survival and Cardiovascular Events after Kidney–Pancreas Transplantation: Comparison with Kidney Transplantation Alone in Uremic IDDM Patients

Abstract

In diabetic patients cardiovascular morbidity and mortality is still a major problem. Our aim was to study the effect of kidney–pancreas transplantation on survival, cardiovascular events, and causes of death in diabetic type I uremic patients. Three hundred and thirty-three uremic IDDM patients were enrolled in our waiting list for kidney–pancreas transplantation: 107 underwent kidney–pancreas transplantation (KP), 34 underwent kidney transplantation alone (KA), whereas 192 patients remained on dialysis (WL). Actuarial survival and causes of death were recorded over a period of 7 years. Seven-year survival rate was 75% for the KP group, 63% for the KA group, and 37% for the WL group (p = 0.001). Cardiovascular death rate was 9.8% in the KP group, 17.6% in the KA group, and 18.1% in the WL group (KP vs. WL, p = 0.05). Rate of acute myocardial infarction in the KP group was lower than in the KA group (2.4% vs. 17.6%, p = 0.005) as well as rate of acute pulmonary edema (0.8% vs. 23.5%, p = 0.0001) and rate of hypertensive patients at 1 (40.9% vs. 85.0%, p = 0.0001) and at 2 years (57.6% vs. 80%, p = 0.03). Kidney–pancreas transplant helped to obtain euglycemia with positive effects on survival and cardiovascular events.