Simultaneous Pancreas-Kidney Transplantation May Reverse Microvascular Damage in Patients with Type 1 Diabetes

In patients with type 1 diabetes and diabetic nephropathy (DN), microvascular structural abnormalities are reversed within 1 year after simultaneous pancreas-kidney transplantation (SPK), reports a study in the American Journal of Transplantation.

The investigators used sidestream dark field (SDF) imaging—an emerging technology for noninvasive visualization of the microcirculation—to study the microvascular morphology of the oral mucosa. Imaging studies were performed in various groups, including 26 patients with DN, 38 patients undergoing SPK, 15 patients with type 1 diabetes, 15 DN patients undergoing kidney transplantation, and 20 healthy control individuals.

The study also included longitudinal SDF imaging in 21 patients with DN undergoing SPK. The microvascular findings were correlated with markers of endothelial dysfunction, including angiopoeitin-1 and angiopoeiten-2 (Ang-1 and Ang-2) and soluble thrombomodulin.

The SDF imaging studies showed increased capillary tortuosity in the DN patients and in the type 1 diabetes group: 1.83 and 1.55, respectively. This value was significantly reduced in patients undergoing SPK, 1.31, compared with no change after kidney transplantation, 1.64. Levels of soluble thrombomodulin and the Ang-2/Ang-1 ratio also normalized after SPK, compared with no change after kidney transplantation. The reversal of capillary tortuosity and decreased markers of endothelial dysfunction were observed within 12 months after SPK.

Simultaneous pancreas-kidney transplantation is an advanced treatment alternative for patients with type 1 diabetes and DN or other forms of microvascular disease. This study, using SDF imaging, suggests that reversal of systematic microvascular abnormalities occurs within 1 year after SPK in patients with DN. No such effect is noted in patients undergoing kidney transplantation only [Khairoun M, et al. Microvascular damage in type 1 diabetic patients is reversed in the first year after simultaneous pancreas-kidney transplantation. Am J Transplant 2013; 13:1272–1281].