Diabetic autonomic neuropathy after pancreas and kidney transplantation

Abstract

Summary. We have evaluated the effect of successful pancreatic and kidney transplantation on autonomic neuropathy in nine Type 1 (insulin-dependent) diabetic subjects. Cardiovascular reflex tests were performed before and at 6-24 months after transplantation. A control group of ten Type I diabetic patients after kidney grafting only was examined at the same time periods. For base-line comparisons results of the tests in ten healthy subjects were used. Advanced autonomic neuropathy was present in both groups of transplant recipients and no significant changes in test results could be found at post-transplant evaluation. Lack of autonomic nerve function improvement was confirmed in seven patients of the pancreatic and kidney transplantation group who were examined again after 2-4 years. Irreversible structural autonomic nerve damage is probably present in uraemic pancreatic transplantation candidates.

Impact of liver transplantation on autonomic neuropathy in familial amyloidotic polyneuropathy: an evaluation by spectral analysis of heart rate variability

“…Conflicting results have been reported from renal and pancreatic-transplanted diabetic patients [21][22][23][24], however, improvement has been found after a follow-up period of 4ϩ years [22,23] therefore the follow-up of 17 months in the present investigation may be too short.…”

Impact of pancreas transplantation on diabetic secondary complications and quality of life

“…Solders et al [56] found an ameliorated R-R variability 4 years after transplantation, but this was true both for kidney/pancreas and renal graft recipients. The other studies [54,[57][58][59] could not demonstrate any significant change in beat-to-beat variation.…”

Is there a relationship between somatic and autonomic neuropathies in chronic alcoholics?

“…In chronic uremia, a study of our group failed to demonstrate a closely parallel involvement of somatic and autonomic functions [10]. Moreover, despite a clear improvement of somatic polyneuropathy, no significant change of autonomic dysfunction was found 6 and 12 months after renal transplantation, as well as up to 4 years after combined kidney-pancreas transplantation [20][21][22][23]. More recently, two different studies performed in diabetes demonstrated a divergent development of autonomic and peripheral somatic neuropathies, suggesting different pathophysiological processes [8,9].…”