Fate of Late Complications in Type I Diabetic Patients After Successful Pancreas-Kidney Transplantation

Abstract

The success rate of pancreas transplantation allows us to study in more detail the potential beneficial effects of normoglycemia on secondary complications in diabetes mellitus. We report a prospective follow-up (mean 26 mo) of metabolic control, neuropathy, retinopathy, and peripheral microcirculation in 31 patients with type I (insulin-dependent) diabetes (mean age 33 +/- 1 yr; mean duration of diabetes 21 +/- 1 yr) after combined kidney and segmental pancreas grafting. All patients had normal HbA1 levels. Glucose tolerance (GT), insulin, C-peptide, and glucagon were normal in 22 patients, and impaired oral GT with reduced insulin secretory capacity was seen in 9 patients. During follow-up, there was no deterioration of GT and insulin release. Vascular risk factors, e.g., hypertension, cholesterol, and triglycerides, decreased after grafting. Autonomic neuropathy improved clinically, and R-R variation increased significantly in 3 of 18 patients. Peripheral neuropathy improved clinically in 46% of patients and did not deteriorate in the others. Motor nerve conduction velocity increased greater than 20% in 8, less than 20% in 12, and was unchanged in 8 of 28 recipients. Most of the patients (n = 30) had pretransplant laser treatment of their advanced retinopathy. Posttransplant visual acuity improved at least more than one line in 56%, stabilized in 32%, and deteriorated in 12% of patients. Patients with functioning grafts for greater than 1 yr had no further deterioration of visual acuity. Vitreous hemorrhage frequency and severity dropped markedly from pretransplant (from 69 to 24%) 10 mo after grafting. Retinal morphology remained stable in all eyes except two.(ABSTRACT TRUNCATED AT 250 WORDS)

Stage-dependent effect of pancreatic transplantation on diabetic ocular complications in the spontaneously diabetic torii rat

“…PTx may not have to be performed at the onset of diabetes, but it is important to decide the timing of PTx alone to prevent or halt the secondary diabetic complications in the future. In addition, although progressive DR was sometimes observed even after PTx (10,11), it was also reported that the course of DR was positively influenced by successful PTx from some clinical data (7)(8)(9). Of interest was the observation that the patients in the study group showing the clear improvements were those in whom the degree of retinopathy was mild, indicating that amelioration can only be expected during the early stages of retinopathy (27,28).…”

“…Within the last decade, immunosuppressive therapy has made great progress, and PTx has evolved as a clinical therapy to reestablish endogenous insulin secretion responsive to normal feedback control. Nevertheless, the clinical data about the effect of PTx on DR are controversial (7)(8)(9)(10)(11). The "point of no return" in DR is still difficult to determine, because most clinical PTxs have been performed during the end stage of diabetes and little is known about the distinctions between the reversible and irreversible alterations of the disease.…”

Verlauf der diabetischen Retinopathie bei einem Zwillingspaar 5 Jahre nach Pankreas-Transplantation

“…Seitdem erschienen eine Vielzahl von Publikationen fiber den Einfluss der PankreasTransplantation auf den Glukosestoffwechsel, Neuropathie and Retinopathie. Landgraf et al konnten zeigen, dass alle erfolgreich transplantierten Patienten frei von exogenem Insulin waren, einen normalen basalen Glukosewert sowie ein normales HbA1C aufweisen [19]. 70% der Patienten haben nach oraler Glukosebelastung einen normalen Glukosetoleranztest, 30 % haben einen gestorten Toleranztest, welcher haufig durch die notwendige Steroidsubstitution erklart ist.…”

“…Seit der Einfuhrung der Pankreas-Transplantation durch Kelly im Jahre 1967 in Minneapolis sind weltweit ca. 4.000 Bauchspeicheldrusen-Verpflanzungen durchgefuhrt worden [19,20,27].…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…Improvements in diabetic microangiopathy in the conjunctival microcirculation have been reported for patients with Type 1 diabetes mellitus after simultaneous kidney-pancreas transplantation (940). Pancreas transplantation has been associated with some improvements in diabetic neuropathy (941)(942)(943)(944), but the fact that neuropathy may also improve after kidney transplantation alone makes it difficult to quantitate improvements due to pancreas transplantation without controlled trials (945). No benefits in macrovascular complications have been demonstrated when comparing recipients of combined kidney-pancreas transplants and kidney transplants alone (946,947).…”