Evolution of the cardiovascular profile after renal transplantation in type 1 diabetic

Renal transplantation is the best treatment for end-stage renal disease (ESRD). Diabetes and chronic kidney disease (CKD) are major cardiovascular (CV) risk factors. Our study focuses on the initial CV profile and its evolution after renal transplantation (RT) in type 1 diabetes (DT1) patients. This is a retrospective study of 4 DT1 patients who benefited from a renal transplantation over the period from 2010 to 2017. In our series of 74 patients receiving a kidney from a living donor, 4 patients (5.4%) had DT 1. Our study concerned these 4 patients: 3 men and 1 woman, mean age: 36.25 years [30–43]. The average duration of diabetes was 25.25 years [13–33]. All patients were hypertensive, one had dyslipidemia and none of them was overweight. Diabetic nephropathy was the cause of end-stage renal failure in all 4 cases and patients were treated with kidney replacement therapy for 2 years (hemodialysis in 2 cases and peritoneal dialysis in 2 cases). Prior to RT, all patients had normal echocardiography and stress testing, 2 patients underwent myocardial scintigraphy without abnormality. None of the patients had coronary angiography. Doppler ultrasonography of the iliac and aortic axes was normal in 1 case, atheromatous infiltration was noticed in 2 patients, and distal mediacalcosis with tight stenosis of both tibial axes was discovered in one case. All patients underwent immunosuppressive therapy with corticosteroids, ciclosporine and mycophenolate mofetil, and followed for an average of 3.25 years. The post RT evolution was marked by an immediate resumption of graft function. Echocardiography control was normal for all 4 patients. One patient presented 2 years later a gangrene of the foot that had been treated by angioplasty of the left superficial femoral artery and amputation of one toe. In DT1 patients, renal transplantation is the best treatment for ESRD despite the use of corticosteroids and anticalcineurins. However, prior explorations of good cardiac function and adequate vascular compliance are essential to reduce the risk of CV.