Albuminuria after fetal pancreatic islet transplantation: A 10-year follow-up

Abstract

Aim of the study. The prevention of diabetic nephropathy is as yet an unresolved issue. The aim of our study was to assess the effects of transplantation of long-term cultured and cryopreserved fetal pancreas islets on metabolic control and the development of diabetic nephropathy. Methods. Serum C-peptide, glucose, HbA(1c), insulin requirements, urinary albumin excretion rate, and blood pressure of 10 insulin-dependent diabetic patients after transplantation were compared with a group of 27 insulin-dependent diabetic controls on insulin therapy only during a 10-year follow-up. Results. In the first year after transplantation mean insulin requirement decreased from 53.6 ± 2.2 to 35.8 ± 1.2 units. C-peptide levels appeared (0.55 ± 0.08 ng/ml) and remained detectable throughout the follow-up. Blood glucose and HbA(1c) were significantly (P < 0.05) lower than in the controls. Mean albumin excretion rates of the transplant and the control groups during the follow up were 18.8 ± 8.5 and 11.7 ± 2.0, 16.6 ± 6.6 and 14.0 ± 2.3, 15.0 ± 5.0 and 15.1 ± 2.7, 15.3 ± 7.5 and 20.4 ± 4.2, 19.8 ± 6,2 and 36.7 ± 11.1, 11.7 ± 3.6 and 51.3 ± 14.6, 14.1 ± 4.2 and 71.4 ± 23.1, 22.7 ± 8.6 and 42.0 ± 28.1, 18.0 ± 5.9 and 107.6 ± 35.6, 21.7 ± 11.0 and 101.5 ± 29.3 μg/min respectively. From the 6th year the difference between the two groups was significant (P < 0.001). In the transplant group initial mean systolic and diastolic blood pressure values were 132.0 ± 3.3 and 81.5 ± 1.5 mmHg, in the controls 130.4 ± 3.4 and 79.6 ± 1.6 mmHg respectively. Significant changes (P < 0.05) of blood pressure during the follow-up or differences between the two groups were not observed. Conclusions. We conclude that fetal islet transplantation is effective in achieving good long-term diabetes control and in the prevention of diabetic nephropathy.