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Preemptive pancreas-kidney transplantation: multidisciplinary follow-up starts too late.

Abstract：

BACKGROUND:Preemptive pancreas-kidney transplantation is increasingly considered at early stages of nephropathy in type 1 diabetics. A multidisciplinary approach is required, but referral to the nephrologist is often delayed. OBJECTIVE:To analyze the referral pattern of type 1 diabetics to a dedicated nephrology unit and to test the prevalence of indications for pancreas-kidney transplantation in this population, according to early preemptive criteria (creatinine >/= 2 mg/dL and/or nephrotic syndrome). PATIENTS AND METHODS:The setting of study was the first Italian Nephrology Outpatient Unit dedicated to diabetics during 1991 to 2002. The main biochemical and clinical parameters were analyzed at referral. RESULTS:Ninety type 1 diabetics underwent at least one nephrological visit during the period; 85 had data at referral. The referral pattern was stable: 1991 to June 1996 [22 men, 24 women of median age 36 (18 to 65) years; diabetological follow-up 18.0 (3 to 37) years] and July 1996 to March 2002 [26 men, 18 women median age 40 (18 to 65); diabetological follow-up 21.5 (11 to 36) years]. The main biochemical data at referral were superimposable: serum creatinine: 1.2 (0.6 to 3.2) versus 1.3 (0.6 to 7) mg/dL; proteinuria: 0.9 (0 to 11) versus 1.01 (0.05 to 12.3) g/24 hours. Diabetes follow-up was greater in July 1996 to March 2002 [18 (3 to 37) versus 21.5 (11 to 36) years] suggesting an effect of improvements in diabetic care. At referral 76.6% were macroproteinuric 85.6% had signs of end-organ damage other than nephropathy; and 30.6% had indications for pancreas-kidney grafting (creatinine >/= 2 mg/dL: n = 6 cases; nephrotic syndrome: n = 10; or both n = 10). CONCLUSIONS:One new frontier of transplantation is the need for early multidisciplinary evaluation of type 1 diabetic patients.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Mezza E,Grassi G,Dani F,Rossetti M,Guarena C,Burdese M,Gai M,Motta D,Bermond F,Soragna G,Jeantet A,Segoloni GP,Piccoli GB

doi

10.1016/j.transproceed.2004.02.035

subject

Has Abstract

pub_date

2004-04-01 00:00:00

pages

580-1

issue

3

eissn

0041-1345

issn

1873-2623

pii

S0041134504001794

journal_volume

36

pub_type

杂志文章

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