OP-0190 Simultaneous pancreas-kidney transplantation effect on progression of diabetic complications in patients with type 1 DM

Aim: Evaluation of the effect of simultaneous transplantation of kidney and pancreas (SPK) on the dynamics of the manifestations of  late complications of diabetes mellitus (DM).
Materials and methods: The study included 21 patients with T1DM after successful SPK. Posttransplantation period at the time of inclusion of patients was 11 months [8;18]. 14 people received standard triple immunosuppressive therapy during the study period, 7 patients canceled steroid therapy after 6 months. The average age was 34 years old [31;40], duration of T1DM 22 years [20,5;28], the duration of diabetic nephropathy10 years[8;14,5]. Donors of SPK were young 29 [25; 33] and transplant cold ischemia time was 8[7;10]hours. Follow-up period was 4,2 years [3,6;4,3]. Kidney transplant dysfunction markers: Cystatin C (serum, urine); NGAL, KIM-1, podocin, nephrin, IL-18, IP-10 (urine), TGF-β1, MMP-9, VEGF-A, OPN (serum) were defined. 
Results: Patients with SPK functioning graft pancreas - 93.75% and kidney -100% of cases. According to a continuous glucose monitoring system using «iPRO2» euglycemia (glycemia(mmol/l)3,9-8,9-89%, lower than 3,9-11%, higher then  8,9-0%) was marked during the day. HbA1c (before study 9.1% [8,7; 11]  decreased to 5.7% [5,55; 5,9], p<0.0001), insulin and  basal C-peptide were 12.5 mkE/ml [11,4; 15,3] and  2.02 ng/ml [1,07; 2,77] respectively ; GFR was 87.6[70;94.4] ml/min/1.73 m2; parathormone - 78[62,3;73,5] pg/ml, phosphorus - 1,2[1;1,3] mmol/l, blood pressure 110[105; 122] mm Hg/70[64; 80] mm Hg, Hb - 116 g/l[109;128,5]. High level and a negative associated of blood cystatin C with GFR (r = - 0,36, p<0.05) and positive with albuminuria (r=0,40, p<0,05), as well as a direct link of podocin urine-with blood creatinine (r = 0,35, p<0.05) and NGAL with albuminuria (r = 0,35, p<0.05) in patients after transplantation were defined. Association between podocin with MMP-9 (r = 0,46, p<0,05) and NGAL (r = 0,33, p<0,05) indicated correlation of renal microstructures stress factors  in posttransplantation patients. In control terms in 10% of cases noted the need for vitrectomy and additional sessions of  photocoagulation of the retina about diabetic retinopathy (20%); newly diagnosed cataract (81.25%), secondary cataracts (25%), glaucoma (25%), macular edema (12.5 %). 35% have ulcers of the lower extremities, 4 patients - manifestation of Charcot's osteoarthropathy, 2 patients underwent amputation with resection of the metatarsal bones, the osteomyelitis in the framework of the diabetic foot syndrome. In connection with the development of stenosing atherosclerosis of vessels of lower extremities, one patient underwent balloon angioplasty and stenting. 
 Conclusion. High levels of renal graft dysfunction biomarkers with euglycemia and renal function normalization after SPK show the persistence of microstructures damage despite stable graft function and the progression of diabetic complications, demonstrate the need to further monitoring and treatment in this category of patients.