Beneficial Effect of Pancreas and Kidney Transplantation on Advanced Diabetic Retinopathy

Abstract

In pancreas recipients with advanced diabetic eye disease, conflicting ophthalmologic results over different follow-up periods have been reported. In the present prospective study we performed ophthalmologic evaluation groups of type I diabetic patients: 1) normoglycemic recipients of pancreas and kidney grafts (group SPK, n = 43, follow-up 44.9 +/- 35.1 months), 2) pancreas and kidney graft recipients with nonfunctioning pancreatic graft, and recipients of isolated kidney graft (group K, n = 45, follow-up 60.3 +/- 34.2 months). The examinations were performed before transplantation, at the end of follow-up (at least 1 year), and in 63 recipients also at 3 years posttransplant. Visual acuity results at baseline and at the end of follow-up were 0.48 +/- 0.39 vs. 0.50 +/- 0.39 in the SPK group, and 0.46 +/- 0.38 vs. 0.40 +/- 0.39 in the K group. While intragroup changes were not significant, the changes were significantly different between the groups (p < 0.05). Fundoscopic findings at the end of follow-up were improved, stabilized, or deteriorated in the SPK group in 21.3%, 61.7%, and 17.0%, respectively. The respective figures for the K group were 6.1%, 48.8%, and 45.1% (p < 0.001). Similar results were obtained when evaluating findings at 3 years posttransplant. Before transplantation, 78% of the SPK group and 81% of the K group had been treated by laser. The need for additional posttransplant laser therapy was significantly lower in the SPK (31%) than in the K group (58%; p < 0.001). In conclusion, pancreas transplant exerts a beneficial effect on the course of diabetic retinopathy even in its late stage.

Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients

“…Our study confirms these results and shows that improvement in retinopathy is maintained at the longer follow-up period of 4 years, as already observed after SPK [34,35]. Also, our series of PTA confirms the positive impact on diabetic neuropathy, as previously reported after SPK, PAK, and PTA [36].…”

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

“…However, many patients still progress to more severe lesions despite improvements in glucose control [4]. After blood glucose normalisation subsequent to simultaneous pancreas-kidney transplantation, a few groups (but not all) observed amelioration of diabetes ocular complications [6][7][8][9][10][11][12][13][14], but it cannot be ruled out that the attendant cure of uraemia might have played an important role [25]. Therefore, studying normoglycaemic pancreas-alone recipients is possibly a better way to assess the effects of normoglycaemia on diabetes complications.…”

“…Lately, the effects of combined pancreas-kidney transplantation on diabetic retinopathy have been described, and conflicting results reported [6][7][8][9][10][11][12][13][14]. Some work showed no significant change or even progression in retinal complications following combined pancreas-kidney transplantation [6][7][8][9].…”

“…In addition, an increased prevalence of posttransplant cataract has also been observed [15]. Other authors, however, reported more consistent improvements, including slower progression of established retinopathy and less need for laser therapy [10][11][12][13][14]. Little information is available with regard to the effects of pancreas transplant alone (PTA) on diabetic retinopathy.…”

Role of simultaneous pancreas-kidney transplantation in the treatment of diabetes mellitus

“…SPKtranszplantációt követően látványosan javul a betegek gastroparesise, a diabeteses neuropathia egy-két éven belül javulni szokott [40,41]. A betegek háromnegye-dének diabeteses retinopathiája a transzplantáció után nem romlik tovább, 10%-uknál javulás is megfi gyelhető [42,43].…”