Outcomes of pancreas transplantation in older diabetic patients

Objective: Improvement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT). Research design and methods: We retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis. Results: Thirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas-kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group 0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE. Conclusions: Long-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients

Membrane Vesicles from the Gut Microbiota and Their Interactions with the Host

Gut microbiota plays an essential role in maintaining intestinal homeostasis and human health. Microbiota establishes a complex network of dynamic and reciprocal interactions with the intestinal epithelium and immune system. The mucin layer that covers the epithelium prevents luminal bacteria from accessing host cells. Thus, microbiota–host communication mainly relies on secreted factors and membrane vesicles (MVs), which can cross the inner mucus layer and reach the epithelium. This chapter focuses on the role of microbiota-secreted MVs as key players in signaling processes in the intestinal mucosa. This is an emerging research topic, with the first reports dating from 2012. Microbiota-derived MVs are involved in interspecies communication in the gut, between bacteria and between microbiota and host. Here we present current knowledge on the mechanisms used by microbiota MVs to assist and control the gut microbial community and to modulate host immune and defense responses. Constant stimulation of immune receptors by microbiota MVs results in tightly controlled inflammation that contributes to tolerogenic responses essential to maintaining intestinal homeostasis. Moreover, gut microbiota MVs are emerging as physical vehicles for distribution and delivery of bacterial effectors to distal tissues in human health and disease