Cardiac Assessment of Patients With Type 1 Diabetes Median 10 Years After Successful Simultaneous Pancreas and Kidney Transplantation Compared With Living Donor Kidney Transplantation Jørn Petter Lindahl, MD, 1,2 Richard John Massey, MSc, 3 Anders Hartmann, PhD, 1,2 Svend Aakhus, PhD, 3,4 Knut Endresen, PhD, 3 Anne Günther, MD, 5 Karsten Midtvedt, PhD, 2 Hallvard Holdaas, PhD, 2 Torbjørn Leivestad, PhD, 2 Rune Horneland, MD, 2 Ole Øyen, PhD, 2 and Trond Jenssen, PhD 2,6 Background. In recipients with type 1 diabetes, we aimed to determine whether long-term normoglycemia achieved by suc- cessful simultaneous pancreas and kidney (SPK) transplantation could beneficially affect progression of coronary artery disease (CAD) when compared with transplantation of a kidney-alone from a living donor (LDK). Methods. In 42 kidney transplant recip- ients with functioning grafts who had received either SPK (n = 25) or LDK (n = 17), we studied angiographic progression of CAD between baseline (pretransplant) and follow-up at 7 years or older. In addition, computed tomography scans for measures of coronary artery calcification and echocardiographic assessment of left ventricular systolic function were addressed at follow-up. Results. During a median follow-up time of 10.1 years (interquartile range [IQR], 9.1-11.5) progression of CAD oc- curred at similar rates (10 of 21 cases in the SPK and 5 of 14 cases in the LDK group; P = 0.49). Median coronary artery cal- cification scores were high in both groups (1767 [IQR, 321-4035] for SPK and 1045 [IQR, 807-2643] for LDK patients; P = 0.59). Left ventricular systolic function did not differ between the 2 groups. The SPK and LDK recipients were similar in age (41.2 ± 6.9 years vs 40.5 ± 10.3 years; P = 0.80) and diabetes duration at engraftment but with significant different mean HbA 1c levels of 5.5 ± 0.4% for SPK and 8.3 ± 1.5% for LDK patients (P < 0.001) during follow-up. Conclusions. In pa- tients with both type 1 diabetes and end-stage renal disease, SPK recipients had similar progression of CAD long-term compared with LDK recipients. Calcification of coronary arteries is a prominent feature in both groups long-term posttransplant. (Transplantation 2017;101: 1261–1267) D iabetes mellitus remains one of the most significant risk factors for development of end-stage renal disease (ESRD). 1 For patients with ESRD, kidney transplantation is, in general, the treatment of choice, offering improved sur- vival compared with continuous dialysis. 2 In patients with both type 1 diabetes and ESRD, simultaneous pancreas and kidney (SPK) transplantation has become an established treatment option. 3-5 The obvious benefit of a functioning pancreas transplant is normalization of blood glucose with- out use of insulin. After a successful kidney transplantation coronary artery disease (CAD) remains the predominant cause of death. 6-8 It is well known that patients with type 1 diabetes and ESRD have a higher rate of morbidity and mortality from CAD than the general population. 9,10 The question whether CAD pro- gression can be halted by transplanting a pancreas simulta- neously with the kidney is important and still debated. Most research on outcomes after kidney transplantation in patients with type 1 diabetes has focused on all-cause mortality. 11-14 Due to lack of organs and center policies, there has been a tendency toward selecting younger patients with type 1 dia- betes and ESRD, often with less comorbidity, to SPK and older recipients to kidney transplantation alone. This has complicated direct posttransplant patient comparison. At Received 16 December 2015. Revision received 29 March 2016. Accepted 29 March 2016. 1 Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 2 Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 3 Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 4 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 5 Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 6 Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway. The authors declare no funding or conflicts of interest. All of the co-authors contributed to each of the following: (1) substantial contribution to conception and design, acquisition of data and/or analysis and interpretation of data; (2) drafting the article and/or revising it critically for important intellectual content and (3) final approval of the version to be published. J.P.L., A.H., and T.J. are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Correspondence: Jørn Petter Lindahl, MD, Department of Transplant Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway. (j.p.h. lindahl@medisin.uio.no). Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/17/10106-1261 DOI: 10.1097/TP.0000000000001274 Original Clinical ScienceçGeneral Transplantation ■ June 2017 ■ Volume 101 ■ Number 6 www.transplantjournal.com 1261 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.