Endocrine Abstracts

Introduction

Simultaneous pancreas-kidney transplantation (PKT) has a beneficial effect on the evolution of chronic complications in type 1 diabetic (T1D) patients with terminal chronic kidney disease (CKD). However, the CKD-mineral and bone disorder (CKD-MBD) remains a frequent complication. There are a few studies addressing the long-term evolution of bone mineral density (BMD) in these patients.

Aim

To characterize baseline BMD and evaluate its long-term evolution in patients with T1D undergoing PKT.

Methodology

A retrospective cohort, including patients submitted to simultaneous pancreas-kidney transplantation in our tertiary center, between 2000 to 2017. The evolution of BMD was assessed by DEXA. Only patients with baseline value and minimum follow-up of 2 years were included.

Results

Seventy-three patients were included, mostly male (53.4%), with a mean age at transplantation of 35.6 ± 5.9 years. At transplantation, mean T-score of the lumbar spine (LS) and femoral neck (FN) was –1.68 ± 1.12 and –2.15 ± 0.77, respectively. Seventy-five percent presented low bone mass (LBM = osteopenia + osteoporosis) in LS and 90% in FN, with 32.9% having criteria for osteoporosis in LS and 35.6% in FN. On the multivariate analysis, male gender (OR 3.59, P = 0.03) and low BMI (OR 0.78, P = 0.03) were significantly associated with lumbar LBM, but not in the femur. At a long term, BMD significantly improved in LS (ΔT-score + 0.41, P < 0.001) and FN (ΔT-score + 0.29, P = 0.01), in a median time of 4 years after PKT. 57.5% maintained LMO in the LS and 86.3% in the FN, with 12.3% achieving osteoporosis criteria in the LS and 16.4% in the FN. There was a positive correlation between BMI and BMD of LS (r = 0.31, P = 0.02) and FN (r = 0.36, P = 0.005). Pancreas graft failure (P = 0.03) was a predictive factor for osteoporosis in FN, but not in the LS.

Conclusion

In the absence of information available on the Z-score, which is best applicable to most of these patients, the use of the T-score shows more than a quarter of T1D patients undergoing PKT to achieve osteoporosis criteria. The significant improvement in BMD may result from metabolic correction with PKT and physiological mineral capitalization of the skeleton that still occurs at these age groups. The evolution of BMD was positively associated with BMI, due to a greater efficiency of the nutritional balance with transplantation.