NEW YORK (Reuters Health) - Among uremic patients with type 1 diabetes, multiple hemostatic abnormalities revert to normal after kidney-pancreas transplantation, according to a report in the September issue of Diabetes. This finding could help explain why patients who undergo this procedure often fare better than those who undergo only kidney transplantation or are untreated.

Dr. Antonio Secchi, from the San Raffaele Scientific Institute in Milan, Italy, and colleagues evaluated several hemostatic parameters in 81 type 1 diabetic patients and in 13 healthy controls. The diabetic subjects included 12 without uremia, 30 with uremia, 27 with uremia who received a kidney-pancreas transplant, and 12 with uremia who received a kidney-only transplant.

Compared with subjects in the other groups, those in the uremic diabetic groups had much larger platelets and had reduced platelet CD41 expression. Calcium levels were higher in the untreated and kidney-only transplant uremic groups than in the other groups.

In contrast to untreated uremic diabetics, patients who received a kidney-pancreas transplant and, to a lesser extent, a kidney-only transplant had levels of hypercoagulability markers comparable to those of control subjects.

Both transplant procedures seemed to increase natural anticoagulant levels to near-normal values. In fact, no hemostatic abnormalities were seen in patients who underwent kidney-pancreas transplantation.

"Uremic type 1 diabetic patients who receive kidney-alone and, to a greater extent, kidney-pancreas transplants have a lower prothrombic state and have a general improvement in the clotting system," the authors note. "This could probably play a positive role in protecting against cardiovascular events and death in (such patients) compared with uremic type 1 diabetic patients who do not receive a transplant."

Diabetes 2004;53:2291-2300

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