Effect of pancreas transplantation on diabetic retinopathy: a 20-case report

Bandello, Francesco; Viganò, Chiara; Secchi, Antonio; Martinenghi, Sabina; Caldara, Rossana; Pozza, G.; Brancato, Rosario

doi:10.1007/bf00587629

Cited by 28 publications

(19 citation statements)

References 6 publications

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“…Improvements seem to be time dependent becoming significant after approximately three years 2. In a comparison of successful and failed pancreas transplants at two years no significant difference was found in degree of retinopathy 3.…”

Section: Literature Reviewmentioning

confidence: 90%

“…Besides these primary benefits, pancreas transplant has been shown to ameliorate the secondary complications of diabetes mellitus including nephropathy, neuropathy, and retinopathy 1. The effect on retinopathy, however, is disputed 2. Pancreas transplant alone (PTA), simultaneous pancreas kidney transplants (SPK), and pancreas transplant after kidney transplant are available options.…”

Section: Introductionmentioning

confidence: 99%

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The effect of combined renal and pancreatic transplantation on diabetic retinopathy

Shipman¹

2009

OPTH

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Section: Literature Reviewmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

The effect of combined renal and pancreatic transplantation on diabetic retinopathy

Shipman¹

2009

OPTH

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“…It has been established that pancreas transplantation, combined with kidney grafting in uraemic Type 1 DM patients (KP-Tx), can near-normalize glucose metabolism; 1 improve protein 2 and lipid 3 metabolism; slow the progression of the Type 1 DM nephropathy 4,5 and neuropathy [6][7][8][9] and, according to some reports, retinopathy. [10][11][12] In theory, the restored glucose-to-insulin Abbreviations: CON-Tx control transplant recipients, KP-Tx recipients of simultaneous kidney and pancreas transplants, PG plasma glucose Sponsors: Istituto Scientifico San Raffaele; Ministero della Sanita'; Consiglio Nazionale delle Ricerche, Contract grant no. : 90.00034.PF70…”

Section: Introductionmentioning

confidence: 99%

Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus

et al. 1998

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Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (CON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PG nadirs than CON-Tx (4.40+/-0.05 vs 4.96+/-0.16 mmol l(-1), ANOVA p = 0.001). Nine per cent of KP-Tx had hypoglycaemic values (PG < or = 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia.

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“…Thus, the interpretation of any additional therapeutic effect of the pancreas graft will be difficult. Therefore, it is not surprising that during the first 3 years after transplantation, patients with a functioning pancreas graft had no significant benefit with respect to retinopathy [79,80,81]. After that time, however, there was a tendency for better stabilization in patients with successful grafts.…”

Section: Diabetic Retinopathymentioning

confidence: 86%

Pancreas organ transplantation

Hopt

Drognitz

2000

Langenbeck's Arch Surg

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Diabetes mellitus is a very common and dreadful disease which cannot be cured by exogenous insulin substitution. Many of the patients suffer from recurrent, and sometimes rather dangerous, hypo- or hyperglycemias and, in the long term, from the well-known secondary diabetic complications. At the moment, pancreas transplantation is the only known therapy to reliably reestablish endogenous insulin secretion responsive to normal feed back controls. Within the last decade, pancreas transplantation has evolved as a clinically well-established procedure. Nevertheless, the perioperative risk after pancreas/kidney transplantation is still higher than after isolated kidney transplantation. However, the benefits of a functioning pancreas graft for the patients are enormous. Ten-year survival of type-I diabetic patients with combined pancreas/ kidney grafts is dramatically better than of those with an isolated kidney graft. Long-term function of the pancreas grafts is excellent, reaching more than 60% after 10 years. Contrary to kidney transplantation, chronic rejection does not seem to be a major problem. Blood glucose levels in the fasting state, after glucose challenge, and in the postprandial state are completely normalized. A significant peripheral hyperinsulinemia, however, is found when the pancreas graft is connected to the systemic venous circulation. Thus, portal venous drainage of the pancreas graft, which is already being performed by a few transplant centers routinely, might be the procedure of choice for the future. Beneficial effects on secondary diabetic lesions can only be expected after a rather long observation period. In addition, for all secondary diabetic complications, there is a point of no return. Nevertheless, significant improvement of diabetic polyneuropathy, diabetic nephropathy, and the disturbed microcirculation has been convincingly demonstrated. The effect on diabetic retinopathy, however, is still controversial. One of the most impressive effects for the pancreas graft recipients seems to be the enormous improvement in quality of life, which is reported unanimously by almost all patients. Thus, simultaneous pancreas/kidney transplantation can be regarded as the optimal and only causal therapy for type-I diabetic patients with end-stage renal disease.

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Effect of pancreas transplantation on diabetic retinopathy: a 20-case report

Cited by 28 publications

References 6 publications

The effect of combined renal and pancreatic transplantation on diabetic retinopathy

The effect of combined renal and pancreatic transplantation on diabetic retinopathy

Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus

Pancreas organ transplantation

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