Abstract
Background
It is virtually unknown whether the restoring of normal glucose metabolism after successful simultaneous pancreas-kidney transplantation (SPK) improves vascular wall morphology and function in type 1 diabetic (T1D) patients. This study has been aimed to compare arterial stiffness, assessed by pulse wave velocity (PWV), carotid intima-media thickness (IMT) biomarkers of arterial wall calcification, and parameters of calcium-phosphate metabolism in T1D patients after SPK or kidney transplantation alone (KTA).
Methods
In 39 SPK and 39 KTA adult patients of similar age, PWV and IMT were measured at a median of 83 (62–109) months post-transplantation. Additionally, carotid plaques were visualized and semi-qualitatively classified. Circulating matrix metalloproteinases (MMPs), calcification biomarkers, and calcium-phosphate metabolism parameters were measured.
Results
Although PWV and IMT values were similar, the occurrence of atherosclerotic plaques (51.3 vs. 70.3%, p < 0.01), turned to be lower, especially in case of calcified lesions (35.9 vs. 64.9%, p < 0.05) in patients after SPK. There were significantly lower concentrations of MMP-1, MMP-2, MMP-3 and osteocalcin (OC) in SPK subjects. Among the analyzed biomarkers, only log MMP-1, log MMP-2 and log MMP-3 concentrations were associated with log HbA1c. In addition, both log MMP-1 and log MMP-3 were inversely related to estimated glomerular filtration rate (eGFR). Multivariate stepwise backward regression analysis revealed that MMP-1 and MMP-3 variability were explained only by log HbA1c, whereas OC variability only by eGFR.
Conclusion
Normal glucose metabolism achieved by simultaneously transplanted pancreas in T1D renal transplant recipients is followed by the favorable profile of circulating matrix metalloproteinases, which may reflect the vasoprotective effect of SPK.
Beneficial Effect of Successful Simultaneous Pancreas-Kidney Transplantation on Plasma Profile of Metalloproteinases in Type 1 Diabetes Mellitus Patients