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Persistent arterial stiffness and endothelial dysfunction following successful pancreas–kidney transplantation in Type 1 diabetes
Author(s) -
Stadler M.,
Theuer E.,
Anderwald C.,
HanuschEnserer U.,
Auinger M.,
Bieglmayer C.,
Quehenberger P.,
Bischof M.,
Kästenbauer T.,
Wolzt M.,
Wagner O.,
Prager R.
Publication year - 2009
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2009.02817.x
Subject(s) - medicine , type 1 diabetes , arterial stiffness , transplantation , endocrinology , plasminogen activator , cardiology , diabetes mellitus , blood pressure
Objective Successful simultaneous pancreas‐kidney transplantation (SPK) in Type 1 diabetic (T1DM) patients results in improved cardiovascular outcome and survival. However, it is doubtful whether the impairment of cardiovascular and endothelial function in T1DM can be completely reversed. Methods Pulse‐wave velocity, stroke volume, heart rate, serological markers of endothelial dysfunction (soluble intercellular, vascular cell‐adhesion molecules, E‐selectin, and plasminogen‐activator‐inhibitor‐1) were measured in 10 T1DM patients after SPK with non‐diabetic glucose levels, 10 T1DM patients with poor [T1DM>8; glycated haemoglobin (HbA1c)>8%], and 10 with good glucose control (T1DM<7, HbA1c<7%), in 6 non‐diabetic patients after kidney transplantation (KT) and 9 non‐diabetic control subjects (CON), matching for major anthropometric characteristics. Results Pulse‐wave velocity was increased in SPK (P < 0.02 vs. CON, KT, T1DM<7) and in T1DM>8 (P < 0.02 vs. T1DM<7). Systolic blood pressure was increased in SPK (P < 0.05 vs. CON). Stroke volume was reduced in SPK, T1DM>8 and T1DM<7 and KT (P < 0.01 vs. CON). Heart rate was elevated in SPK and in T1DM>8 (P < 0.0003 vs. CON and T1DM<7). In SPK, soluble intercellular and vascular cell‐adhesion molecules were 100% and 44% higher (P < 0.03 vs. CON), respectively, while plasminogen‐activator‐inhibitor‐1 was decreased in SPK (P < 0.02 vs. CON). Conclusion T1DM patients after SPK experience arterial stiffness, a higher heart‐rate and blood pressure, reduced stroke volume and serological signs of endothelial dysfunction. Thus, functional and structural cardiovascular alterations as a result of glucotoxicity, uraemia and hypertension in T1DM might not be completely resolved by SPK.