Abstract 3766: Persistent Platelet Activation After Simultaneous Pancreas-kidney Transplantation In Patients With End-stage Renal Disease And Diabetes Type I
Background: Simultaneous pancreas-kidney transplantation (SPKT) reduces the high morbidity and mortality of patients with end-stage renal disease(ESRD) and diabetes type 1 (DM-I). Nevertheless cardiovascular disease and its complications still remain the major cause for mortality in these patients. Activated platelets play a pivotal role in the genesis of atherosclerosis and its ischemic complications in patients with DM-I. Platelet function has been poorly evaluated so far in patients after SPKT.
Aim: Prospective examination of platelet function in patients before and after SPKT, and in regard to the influence of co-medication, immunosuppressive therapy and time since transplantion.
Methods: We examined systemic platelet activation with the use of immunological platelet surface markers (CD62P, CD63, LIBS-1 (activated fibrinogen receptor) and PAC-1) and whole blood flow cytometry in 48 patients (17 female, age 49.7±1.2 years,) before and 112 patients (46 female, age 48.7±0.8 years, mean time since transplantation 6.6±0.2 years) after SPKT, in comparison to a control group (n=78).
Results: Although there were significant improvement of metabolic control (HbA1c: 6.0± 0.1%) and the renal function (creatinine: 1.4±0.06 mg/dl) after SPKT, we found no significant differences in platelet activation in patients before and after SPKT. Both groups showed increased platelet activation markers compared to the control group. A subgroup analysis in regard to immunosuppressive therapy revealed that SPKT patients with tacrolimus (n=72) showed significantly increased expression of CD62P (p=0.029) and CD63 (p=0.02) compared to SPKT patients with cyclosporin (n=14), rapamycin (n=25) and azathioprine (n=1). Time since transplantation and co-medications as a-blockers, ß-blockers, calcium channel blockers, ACE-inhibitors, angiotensin-receptor-blockers and statins had no influence on measured platelet markers.
Conclusion : In spite of the improved renal function and the new euglycemic state after SPKT, platelet activation is still increased and might represent a possible cause for persistent risk for cardiovascular events in these patients. Future studies have to show if these patients might benefit from an effective antiplatelet strategy.