Long term metabolic outcomes following transplantation in type I diabetes recipients

Abstract

Type I diabetes mellitus affects approximately 10% of diabetic patients, with up to 50% lifetime risk of developing end stage kidney disease. Renal replacement therapy in the form of dialysis is often unsustainable, however simultaneous pancreas-kidney (SPK) and kidney only transplantation (KTx) are viable long-term treatment options in appropriate surgical candidates. Despite advances in life expectancy post-transplant, cardiovascular disease continues to account for significant morbidity and mortality in transplant populations. The effect of transplantation on long term metabolic outcomes and modification of risk associated with macrovascular disease (peripheral vascular disease, coronary artery disease, cerebrovascular events) has not been extensively interrogated following SPK or KTx. The aim of this thesis was to evaluate long-term metabolic parameters (lipid profile, renal function, glycaemic control) and macrovascular disease profiles in SPK and KTx post-transplant as prognosticating factors to further inform long-term management in type I diabetes transplant recipients with end stage kidney disease.