Outcomes From Brain Death Donors With Previous Cardiac Arrest Accepted for Pancreas Transplantation: A Single-center Retrospective Analysis.

OBJECTIVE: The aim of the study was to evaluate the effect of cardiac arrest time (CAT) in donors after brain death (DBD) donors on pancreas transplant outcome. SUMMARY OF BACKGROUND DATA: Results from donors after circulatory death report good outcomes despite warm ischemia times up to 57 minutes. Previous cardiac arrest in DBD has been addressed as a potential risk factor, but duration of the CAT has never been evaluated. METHODS: We conducted a retrospective analysis including 342 pancreas transplants performed at our center from 2000 to 2016, and evaluated the effect of previous cardiac arrest in DBD (caDBD) on pancreas transplant outcomes. RESULTS: A total of 49 (14.3%) caDBD were accepted for transplantation [median CAT of 5.0 min (IQR 2.5-15.0)]. Anoxic encephalopathy was most frequent and P-PASS higher (16.9 vs 15.6) in caDBD group when compared with other DBD. No differences were found in all other characteristics evaluated.Graft survival was similar between both groups, as was the incidence of early graft failure (EGF). CAT increased the risk for EGF [OR 1.09 (95% CI, 1.01-1.17)], and the duration of CPR discriminated for EGF [AUC of 0.86 (95% CI, 0.74-0.98)], with a sensitivity and specificity of 100% and 75% at a cutoff of 15 minutes. When evaluated separately, caDBD >15 min increased over 5 times the risk for EGF [HR 5.80 (95% CI, 1.82-18.56); P = 0.003], and these presented fewer days on the ICU (1.0 vs 3.0 d). CONCLUSION: CaDBD donors are suitable for routine pancreas transplantation without increasing EGF risk, and in those with longer CAT it may be prudent to postpone donation a few days to allow a thorough evaluation of organ damage following cardiac arrest.

Genotipo de la haptoglobina y riesgo de nefropatía diabética en pacientes con diabetes mellitus tipo 1: estudio en población española / Haptoglobin genotype and risk of diabetic nephropathy in patients with type 1 diabetes mellitus: a study on a Spanish population

Antecedentes: Pocos trabajos han estudiado la asociación entre el genotipo de la haptoglobina (Hp) y el riesgo de nefropatía diabética (ND) en pacientes con diabetes tipo 1 (DM1), con resultados contradictorios hasta ahora.Objetivos: Estudiar si el genotipo 2-2 de Hp se asocia a un incremento del riesgo de ND en población española con DM1. Métodos: Se diseñó un estudio de casos y controles. CASOS: pacientes con DM1 y enfermedad renal crónica estadio 5 de la NKF-KDOQI, en espera de trasplante reno-pancreático o que han sido trasplantados (reno-pancreático o renal aislado). CONTROLES: pacientes con DM1, apareados por sexo y tiempo de evolución de la diabetes, con función renal y excreción urinaria de albúmina normales. El genotipo de Hp se realizó mediante reacción en cadena de la polimerasa y electroforesis. Resultados: Incluimos 57 casos y 57 controles, sin diferencias estadísticamente significativas en el sexo (70 % frente a 61 % varones, p = 1,0) o duración de la diabetes (23,0 ± 6,7 frente a 20,8 ± 9,3 años; p = 0,1), aunque la edad de inicio de la diabetes fue menor en los casos (14,1 ± 6,8 frente a 17,7 ± 10,1 años, p = 0,03). La frecuencia de genotipos 1-1, 1-2 y 2-2 fue de 19,3 %, 42,1 % y 38,6 % en los casos y de 17,5 %, 49,1 % y 33,4 % en los controles, respectivamente, sin diferencias significativas (p = 0,8). El análisis de regresión logística condicional no mostró asociación entre el genotipo 2-2 de Hp y el desarrollo de ND (OR 1,14, IC 0,52-2,52). Conclusiones: En nuestra muestra de población española con DM1, no se ha hallado asociación entre el genotipo de Hp y el riesgo de ND (AU)

Background: Few reports have studied the possible association between the haptoglobin (Hp) genotype and the risk of diabetic nephropathy (DN) in type 1 diabetes (T1D), with conflicting results to date. Aims: To study whether the 2-2 Hp genotype is associated with an increased risk of overt DN in a Spanish population with T1D. Methods: We performed a case-control study in a Spanish population. CASES: T1D patients with end-stage renal disease (stage 5 of NKF-KDOQI), awaiting reno-pancreatic transplantation or having already been transplanted (reno-pancreatic or renal alone). CONTROLS: T1D patients, matched for sex and time of diabetes evolution, with preserved renal function and normal urinary albumin excretion. Hp genotyping was done using polymerase chain reaction and electrophoresis. Results: We included 57 cases and 57 controls in the study. There were no statistically significant differences in gender (70% vs. 61% males, p=1.0) or the duration of diabetes (23.0±6.7 vs. 20.8±9.3 years; p=0.1), although the age of onset of diabetes was lower in the cases (14.1±6.8 vs. 17.7±10.1 years, p=0.03). The frequency of genotypes 1-1, 1-2 and 2-2 was 19.3%, 42.1% and 38.6% in cases and 17.5%, 49.1% and 33.4% in controls, respectively, with no statistically significant differences between groups (p=0.8). Conditional logistic regression analysis showed no significant association between genotype 2-2 of Hp and the development of DN (OR 1.14, CI 0.52-2.52). Conclusions: In our sample of a Spanish population with T1D, no association was found between the Hp genotype and risk of overt DN (AU)

Haptoglobin genotype and risk of diabetic nephropathy in patients with type 1 diabetes mellitus: a study on a Spanish population.

BACKGROUND: Few reports have studied the possible association between the haptoglobin (Hp) genotype and the risk of diabetic nephropathy (DN) in type 1 diabetes (T1D), with conflicting results to date. AIMS: To study whether the 2-2 Hp genotype is associated with an increased risk of overt DN in a Spanish population with T1D. METHODS: We performed a case-control study in a Spanish population. CASES: T1D patients with end-stage renal disease (stage 5 of NKF-KDOQI), awaiting reno-pancreatic transplantation or having already been transplanted (reno-pancreatic or renal alone). CONTROLS: T1D patients, matched for sex and time of diabetes evolution, with preserved renal function and normal urinary albumin excretion. Hp genotyping was done using polymerase chain reaction and electrophoresis. RESULTS: We included 57 cases and 57 controls in the study. There were no statistically significant differences in gender (70% vs. 61% males, p=1.0) or the duration of diabetes (23.0 ± 6.7 vs. 20.8 ± 9.3 years; p=0.1), although the age of onset of diabetes was lower in the cases (14.1 ± 6.8 vs. 17.7 ± 10.1 years, p=0.03). The frequency of genotypes 1-1, 1-2 and 2-2 was 19.3%, 42.1% and 38.6% in cases and 17.5%, 49.1% and 33.4% in controls, respectively, with no statistically significant differences between groups (p=0.8). Conditional logistic regression analysis showed no significant association between genotype 2-2 of Hp and the development of DN (OR 1.14, CI 0.52-2.52). CONCLUSIONS: In our sample of a Spanish population with T1D, no association was found between the Hp genotype and risk of overt DN.

Enteric-coated mycophenolate sodium in de novo and maintenance kidney-pancreas transplant recipients.

BACKGROUND: Our objective was to describe efficacy and safety of enteric-coated mycophenolate sodium (EC-MPS) in de novo and maintenance recipients of kidney-pancreas transplant in the clinical practice. METHODS: Observational, multicentre, prospective, 12-month study. RESULTS: We included 24 de novo and 24 maintenance patients. EC-MPS mean (± SD) doses at initiation in de novo patients were 1440 ± 0 vs. 1268 ± 263 mg/d at month 12 (M12). Patient and renal graft survival at one yr were 100%, and pancreatic graft survival was 83.3% (two losses owing to technical failure and two owing to rejection). In the maintenance cohort, EC-MPS was introduced at a median (P25-P75) of 30 (6-71) months after transplant. Baseline doses were 585 ± 310 vs. 704 ± 243 mg/d at M12. In this group, a significant increase in creatinine clearance was observed (65 ± 22 at baseline vs. 74 ± 20 mL/min at M12, p = 0.011). Patient, renal, and pancreatic graft survival were 100%, 95.8%, and 100%, respectively (one kidney graft loss owing to rejection). During follow-up, one patient from each group discontinued EC-MPS. CONCLUSIONS: The efficacy of EC-MPS in the clinical practice of kidney-pancreas transplantation is good, with high patient and grafts survival at 12 months, and good safety profile. The maintenance group displayed an improvement in renal function.

Renal transplantation in HIV-infected patients: 2010 update.

The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm(3) and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft.

Prevalence of cardiovascular risk factors in patients with type 1 diabetes in end-stage renal disease: changes in the trend from 1999 to 2006.

OBJECTIVE: The aim of this study was to describe the prevalence of cardiovascular disease risk factors (CVDRFs) and the degree of control in a Spanish population of patients with type 1 diabetes (DM1) and end-stage renal disease (ESRD) as well as the changes observed in this setting over 8 years. DESIGN AND METHODS: Patients with DM1 and ESRD were evaluated from 1999 to 2006. Clinical variables, smoking habit, glycosylated hemoglobin (HbA(1c)) and lipids values, and drug treatment were evaluated. The cohort was divided into four biannual groups for analysis. HbA(1c) >7, LDL >100 mg/dl, blood pressure (BP) >140/90 mmHg, and tobacco use were considered as CVDRFs. RESULTS: A total of 177 patients (65% male) with a mean age of 37.2+/-6.2 years were studied. They had 24.3+/-5.9 years of diabetes evolution. Mean HbA(1c) was 7.9+/-1.5% with 29.6% of patients having values less than 7%. Mean LDL was 109.3+/-40.4 mg/dl and 41.1% were below 100 mg/dl. Over the years these proportions increased significantly (P=.028 and .0015, respectively). Mean systolic and diastolic BP were 142.5+/-22.9 and 82.2+/-14.9 mmHg, respectively, with 53.8% of patients having BP <140/90 mmHg with no changes over the years (P=.11). The proportion of never smokers was 51.5%, reaching 65.5% in the last biannual period (P=.01). In the whole cohort, 89.3% had one or more CVDRFs. There was a statistically significant trend to a reduction in the number of CVDRFs over time (r=-.208, P=.005). CONCLUSIONS: CVDRFs are highly prevalent in patients with DM1 and ESRD. The control of these CVDRFs is still insufficient; however, there has been a clear improvement in the control over the years.

Hypoglycaemia after pancreas transplantation: usefulness of a continuous glucose monitoring system.

BACKGROUND: After pancreas transplantation (PTx) some patients report occasional symptoms of hypoglycaemia and at times, serious hypoglycaemia. Continuous blood glucose monitoring (CBGM) allows determination of the daily glucose profile and detection of unrecognized hypoglycaemia. The aims of our study were to determine the incidence of hypoglycaemia in PTx and evaluate whether the use of CBGM helps to detect unrecognized nocturnal hypoglycaemia. PATIENTS AND METHODS: We studied 12 patients (six males) with normal functioning PTx and kidney transplantation for more than 3 yr, with systemic drainage of endocrine secretion and stable immunosuppression. A 24-h CBGM using a microdialysis technique (GlucoDay, A. Menarini Diagnostics, Florence, Italy) was performed in all the patients. RESULTS: Three patients had asymptomatic recorded glucose levels below 3.3 nmol/L during the nocturnal period (01:00-07:00 hours) with the glucose levels during these episodes being 2.6, 2.5 and 2.5 nmol/L, and the duration of nocturnal hypoglycaemia being 27, 62 and 93 min, respectively, rising spontaneously without intervention. Patients with hypoglycaemia presented lower glycosylated haemoglobin levels when compared with those not presenting hypoglycaemic episodes, although basal glucose and insulin levels and insulin antibody titres were similar. In one of the three patients presenting hypoglycaemia CBGM was re-evaluated after including an extra snack at bedtime, with subsequent normalization of the blood glucose profile being observed. CONCLUSION: Unrecognized nocturnal hypoglycaemia is relatively frequent in patients with PTx and 24-h CBMG may be useful to detect these episodes.

[Effects of kidney and pancreas transplantation on neurophysiological rates of polyneuropathy and autonomous cardiac function in diabetic patients with end-stage renal disease]. / Efectos del trasplante de riñón y páncreas en los índices neurofisiológicos de polineuropatía y función autonómica cardiorreguladora en pacientes diabéticos con insuficiencia renal terminal.

BACKGROUND: Patients with type 1 diabetes mellitus (DM1) and end-stage renal disease (ESRD) usually exhibit a severe polyneuropathy (PNP) whose progression can be halted after kidney and pancreas transplantation (KPT). We studied the evolution of both PNP and autonomous cardioregulatory function (ACF) in patients with DM1 and ESRD within the first year after KPT. PATIENTS AND MEHTOD: The study was carried out in 26 patients who underwent KPT and whose organs were functioning normally at least during one year after KPT. They were examined neurophysiologically in three different periods: a) before KPT; b) 1-3 months after KPT, and c) 12 months after KPT. We evaluated PNP by measuring the conduction velocity (CV) and the amplitude of the compound action potentials (ACAP) of common peroneal, posterior tibial and sural nerves. ACF was evaluated by measuring the change in the interval separating two consecutive QRS complexes in the electrocardiogram during quiet breathing and Valsalva manoeuvre. RESULTS: All patients had a severe PNP before KPT. Ten patients (38.4%) showed a significant reduction in ACAP and ACF in the exam carried out within 1 to 3 months after KPT, whereas all patients showed an increase in the CV, ACAP and ACF at 1 year after KPT. CONCLUSIONS: KPT induces a significant improvement of neurophysiological signs of PNP and of ACF, which is statistically significant at 1 year after KPT. In some patients, the improvement is heralded by an increase in the axonal damage, occurring in the first months after KPT, which may be due the aggression from the surgical treatment and related events.