Normalization of multiple hemostatic abnormalities in uremic type 1 diabetic patients after kidney-pancreas transplantation

Background and Aims
Aim of this study is to evaluate the effects of kidney or kidney-pancreas transplantation on haemostatic abnormalities in uremic type 1 diabetic patients.
Materials and Methods
This is a cross-sectional study involving 12 type 1 diabetic patients (T1DM), 30 uremic type 1 diabetic patients (U+T1DM), 27 uremic type 1 diabetic kidney-pancreas transplanted patients (KP), 12 uremic type 1 diabetic kidney-alone transplanted diabetic (KD) and 13 healthy controls (C). Platelets morphology, receptors and intracellular signalling, markers of hypercoagulability and natural anti-coagulants were evaluated.
Results
a) Platelets morphology: The U+T1DM group showed higher platelet size than all the other groups (p<0.01).
b) Platelets signalling: Resting calcium was statistically higher in the U+T1DM and KD group than in the KP/C groups (U+T1DM=137.6±11.2, KD=133.3±16.6, KP=97.2±9.2, C=72.0±11.0, T1DM=60.9±7.7, nM, p<0.01).
c) Platelets receptors: The U+T1DM group showed a statistical reduced platelets CD41 expression as compared to all the other groups (U+T1DM=53.2±7.7, KD=75.7±6.2, KP=80.4±4.3, C=81.6±2.2%, T1DM=82.6±3.4, p<0.01). Diabetics patients showed higher levels of thrombin platelets expression than non diabetics.
d) Hypercoagulability markers and natural anti-coagulants: The KP, and to a lower extent the KD, but not the U+T1DM group, showed levels of hypercoagulability markers similar to the C group. A reduction in anticoagulant activity was evident in the U+T1DM group, while near-normal values were observed in the KP/KD groups.
Conclusions
Haemostatic abnormalities were not observed in KP patients, while they were present, at different degree, in KD/U+T1DM patients. This explain the lower cardiovascular death rate observed in KP patients than in KD/U+T1DM.
Key-words: Uremia, type 1 diabetes mellitus, platelets, hemostatic abnormalities, anticoagulant activity.