Influence of Pancreas Transplantation on Cardiorespiratory Reflexes, Nerve Conduction, and Mortality in Diabetes Mellitus

Abstract

Cardiorespiratory reflexes (CRR) were studied by measuring heart-rate variation during 6 breaths/min respiration and a Valsalva maneuver in 232 insulin-dependent diabetic subjects. Abnormalities were found in 175 patients. During a 7-yr follow-up, 41 (23.4%) patients with abnormal and 2 (3.5%) with normal CRR tests died. The mortality rates of diabetic patients with abnormal autonomic function tests were 17% at 2.5 yr, 33% at 5 yr, and 40% at 7 yr, significantly higher (P less than 0.002) than in patients with normal tests (rates of 4.6, 4.6, and 13.8% at the respective intervals). Nerve conduction studies (NCS) were indicative of somatic neuropathy in 148 of 205 patients. Mortality rates were higher in patients with abnormal NCS than in those with normal results (P less than 0.025). Among patients with abnormal autonomic function, patients with a functioning pancreas transplantation (PTx) had better survival rates than patients with a failed PTx (P less than 0.005) and, on long-term follow-up, better rates than patients without PTx. Similar results were found comparing the same group of patients who had abnormal NCS.

Corneal Confocal Microscopy Detects Early Nerve Regeneration in Diabetic Neuropathy After Simultaneous Pancreas and Kidney Transplantation

“…This is in contrast to all other standard measures of neuropathy, including detailed QST, autonomic function, electrophysiology, and IENFD, all of which failed to show an improvement 12 months after SPK. These findings support previous studies in diabetic neuropathy where at best a prevention of progression in nerve damage was shown only after several years of euglycemia (5–8,48–51). However, these studies focused heavily on electrophysiology and quantitative sensory assessment, which predominantly assessed large fiber function.…”

Altered Control of Ventilation in Streptozotocin-Induced Diabetic Rats

“…One major contributor to the diminished ventilatory responses in diabetic rats may be associated with development of autonomic neuropathy . Navarro and coworkers (19) documented abnormalities of cardiopulmonary reflexes in 75% of the 232 insulin-dependent diabetic patients. Many of these patients had evidence of somatic and autonomic 3a.…”

Regenerative Therapies for Diabetic Microangiopathy

“…Studies performed on pancreas-transplanted patients have shown that diabetic glomerular lesions affecting their own kidneys prior to transplantation were not ameliorated by 5 years of normoglycaemia, while an improvement was observed after 10 years [12, 13] (Table 1). Different studies have shown that neuropathy progression (and the associated vascular degeneration) can be halted by successful pancreas transplantation [15, 25, 26]. Martinenghi et al reported that progressive amelioration of nerve conduction velocity was prominently related to the pancreas graft, given that in a cohort of kidney-pancreas-transplanted patients, the failure of the pancreas, that occurred at least 2 years after successful combined transplantation, was associated with a deterioration of nerve conduction velocity back to pretransplant levels [27].…”