Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011854 (type 1 diabetes)
 20,749 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

1. The numbers of CGN patients have decreased, with a corresponding increase in transplants into IDDM. HTN and MHT have also increased in recent years. 2. Waiting time on dialysis has increased, with an increase in patient age. 3. Transfusions have decreased for all diseases, although less so for SLE. 4. Disease recurrence was highest in FGS, IgA, SLE and CGN. The incidence of recurrence has decreased in recent years. 5. Tacrolimus-MMF and Neoral-MMF were superior to CsA-AZ for all diseases with respect to 5-year graft survival. 6. Systemic diseases such as SLE and IDDM had lower graft survival rates than IgA, PC and ALP. Exclusion of deaths made functional graft survival of all diseases quite similar. 7. Blacks had lower graft survival rates than Whites, Hispanics, and Asians for all diseases. 8. SPK had higher graft survivals than KA in Blacks and Whites. 9. PC patients with HLA-DR1 had a statistically significant higher graft survival than those without DR1 in Whites and Hispanics. 10. IDDM patients with HLA-DR4 had a statistically significantly higher graft survival rates than those without DR4 in Blacks, Whites, Hispanics, and Asians. 11. PC, IgA, and ALP patients had a lower incidence of rejection before discharge than other patients. HTN and IDDM patients had the highest rate of first day non-function and need for dialysis. 12. Need for dialysis and rejection before discharge led to 20 percentage points lower 5-year graft survival compared with those patients who were free of these complications. 13. First day anuria led to 10 percentage point lower 5-year graft survival compared with those with first day diuresis.
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PMID:Effect of primary diseases. 1538 26

Between 1966 and 1997, over 10 000 pancreas transplants were performed worldwide, 88% of these being simultaneous kidney-pancreas transplantations (SKPTs). The overall 1-year patient survival rate exceeds 90%, and the graft survival (complete insulin independence) rate is 80%. SKPT should be regarded as the treatment of choice in carefully selected patients with type 1 (insulin-dependent; IDDM) diabetes mellitus and advanced nephropathy, because of its ability to offer superior glycaemic control and an improved quality of life. Studies have shown that the addition of a pancreas transplant does not appear to jeopardise either the patient or the kidney transplant, as many centres report either similar or improved survival rates after SKPT compared with kidney transplantation alone. Indications for solitary pancreas transplantation are based on the presence of early, well defined diabetic complications or glucose hyperlability with poor quality of life. Improvements in quality of life and possible prevention of further morbidity associated with diabetes makes pancreas transplantation an important therapeutic option for selected diabetic patients. According to registry data from the United Network for Organ Sharing (UNOS) Registry, rejection accounts for 32% of graft failures in the first year after pancreas transplantation. Most pancreas transplant centres employ quadruple drug immunosuppression with antilymphocyte induction with either a monoclonal or polyclonal agent. Maintenance immunosuppression involves triple therapy, consisting of a calcineurin inhibitor (cyclosporin or tacrolimus), corticosteroids and an antimetabolite (azathioprine or mycophenolate mofetil). Before 1995, nearly all pancreas transplant recipients were managed with the original formulation of cyclosporin ('Sandimmun'). In the past 2 years, tacrolimus-based therapy has been used in approximately 20% of cases and a new microemulsion formulation of cyclosporin ('Neoral') has replaced the original formulation in contemporary post-transplant immunosuppression. In addition, mycophenolate mofetil is replacing azathioprine as part of the standard immunosuppressive regimen after pancreas transplantation. At present, a number of centres are conducting various trials with new drug combinations including either cyclosporin microemulsion or tacrolimus in combination with corticosteroids and mycophenolate mofetil with or without antibody induction therapy. The current array of new immunosuppressive agents is providing more effective control of rejection and permitting solitary pancreas transplantation to become an accepted treatment option in diabetic patients without advanced complications. Immunosuppressive strategies will continue to evolve to achieve effective control of rejection while minimising injury to the allograft and risk to the patient. In addition, new regimens must not only address the issue of specific drug toxicities but also long term economic, metabolic and quality-of-life outcomes.
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PMID:Pancreas transplantation for diabetes mellitus: a guide to recipient selection and optimum immunosuppression. 1802 Jun 7