The effect of combined renal and pancreatic transplantation on diabetic retinopathy

Shipman, Kate E.

doi:10.2147/opth.s7141

Cited by 11 publications

(8 citation statements)

References 14 publications

(24 reference statements)

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“…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].…”

Section: Discussionsupporting

confidence: 92%

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

Boggi

Vistoli²,

Amorese³

et al. 2011

Rev Diabet Stud

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■ AbstractWe report on our single-center experience with pancreas transplantation alone (PTA) in 71 patients with type 1 diabetes, and a 4-year follow-up. Portal insulin delivery was used in 73.2% of cases and enteric drainage of exocrine secretion in 100%. Immunosuppression consisted of basiliximab (76%), or thymoglobulin (24%), followed by mycophenolate mofetil, tacrolimus, and low-dose steroids. Actuarial patient and pancreas survival at 4 years were 98.4% and 76.7%, respectively. Relaparatomy was needed in 18.3% of patients. Restored endogenous insulin secretion resulted in sustained normalization of fasting plasma glucose levels and HbA1c concentration in all technically successful transplantations. Protenuria (24-hour) improved significantly after PTA. Renal function declined only in recipients with pretransplant glomerular filtration rate (GFR) greater than 90 ml/min, possibly as a result of correction of hyperfiltration following normalization of glucose metabolism. Further improvements were recorded in several cardiovascular risk factors, retinopathy, and neuropathy. We conclude that PTA was an effective and reasonably safe procedure in this single-center experience.

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Section: Discussionsupporting

confidence: 92%

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

Boggi

Vistoli²,

Amorese³

et al. 2011

Rev Diabet Stud

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“…Several studies conducted in our laboratory have previously shown that PT is not only able to restore the endocrine balance in ALX-induced diabetic rats but can also prevent or stabilize the progression of diabetic lesions in the kidneys, eyes, nerves and lungs of these animals [45][46][47][48]. These findings have been confirmed by others in humans [4][5][6][7]. However, studies on the effects of PT on testicular lesions are rare, particularly those involving long-term follow-up for up to 50 weeks after transplantation or until 62 weeks of age.…”

Section: Discussionsupporting

confidence: 69%

“…Successful pancreas transplantation (PT) is currently seen as the only treatment that can modify the expected natural history of diabetic complications in insulin-dependent DM, as is able to delay the progression, stabilize, and even reverse many complications of the disease in the kidneys, vessels, eyes, and nerves of patients [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Pancreas Transplantation Delays the Progression of Morphological, Morphometric and Ultrastructural Changes in Testes of Alloxan-Induced Diabetic Rats

Spadella

Trindade

Lucchesi

et al. 2017

Exp Clin Endocrinol Diabetes

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The aim of this study was to assess the effects of pancreas transplantation on the progression of testicular lesions in diabetic rats. Diabetic rats were subjected to pancreas transplantation and sacrificed after 6, 14, 26 and 50 weeks of follow-up, using non-diabetic and untreated diabetic rats as controls. Successful pancreas transplantation corrected all of the metabolic changes observed in diabetic rats, including low levels of testosterone. The testicular mass was decreased, and the relative weight of the testes was high in diabetic rats. The seminiferous tubules of diabetic rats showed progressive atrophy of the germinal epithelium, with cytoplasmic vacuolization, detachment of germ cells to the tubular lumen and the appearance of giant cells. Leydig cells were abnormally distributed, and hyperplasia of Sertoli cells was observed. Sperm were not detectable within the tubular lumen in late follow-up. The diameter, total area, lumen area, and germinal epithelium area of the seminiferous tubules were low, and tubular density was high in diabetic rats. Ultrastructural changes were also observed in these rats, compromising the cytoplasm, organelles and cellular nuclei of the germ, Sertoli, and Leydig cells. The most frequent changes consisted of accumulation of lipid droplets and electron-dense dark material in the cell cytoplasm, cellular degeneration and apoptosis. Similar to non-diabetic rats, pancreas-transplanted rats showed progressive testicular lesions, but they were much less severe and occurred much later than in the untreated diabetic controls. Diabetes causes morphological and ultrastructural changes in rat testes, but the progression of lesions can be significantly delayed by successful pancreas transplantation, which may have a positive impact on male infertility due to diabetes.

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“…Thus, retinal complications associated with these conditions may be expected in this group of patients. Previously existing diabetic retinopathy may worsen, remain stable or improve, 4 - 8 and post-transplantation blood glucose control does not halt its progression, especially in patients not receiving adequate specific treatment in the preoperative period. 4 …”

Section: Discussionmentioning

confidence: 99%

Retinal changes in solid organ and bone marrow transplantation patients

Malerbi

Teixeira

Hirai

et al. 2017

Einstein (São Paulo)

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Objective To evaluate retinal changes in patients who underwent solid organ or bone marrow transplantation.Methods A retrospective analysis of medical records of patients evaluated from February 2009 to December 2016. All patients included underwent funduscopy. Clinical and demographic data regarding transplantation and ophthalmological changes were collected.Results A total of 126 patients were analyzed; of these, 108 underwent transplantation and 18 were in the waiting list. Transplantation modalities were heart, lung, kidney, liver, pancreas, combined pancreas and kidney and bone marrow transplantation. The main pre-transplantation comorbidities were diabetes and arterial hypertension. Of the 108 transplanted patients, 82 (76%) had retinal changes. All patients who underwent pancreas or combined pancreas and kidney transplantation had diabetic retinopathy. The main retinal changes found were diabetic retinopathy, hypertensive retinopathy, retinal vascular occlusions, chorioretinal infections and central serous chorioretinopathy.Conclusion Retinal changes were either related to preexisting conditions, mainly diabetic retinopathy, or developed postoperatively as a complication of the surgical procedure, or as an infection related to the immunosuppressive status, or due to drug toxicity. These patients may present with complex ophthalmological changes and should be carefully evaluated prior to surgery and further followed by an ophthalmologist skilled in the management of diabetic retinopathy and posterior pole infections.

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The effect of combined renal and pancreatic transplantation on diabetic retinopathy

Abstract: This case report describes the effect of simultaneous pancreas kidney transplant (SPK) on the diabetic retinopathy (DR) of two male type 1 diabetic patients. The literature on the effect of SPK on DR is reviewed and the evidence surrounding visual function outcomes is discussed.

Cited by 11 publications

References 14 publications

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

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

Pancreas Transplantation Delays the Progression of Morphological, Morphometric and Ultrastructural Changes in Testes of Alloxan-Induced Diabetic Rats

Retinal changes in solid organ and bone marrow transplantation patients

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