Diabetic Neuropathy 3 Years After Successful Pancreas and Kidney Transplantation

Abstract

Twenty-seven patients with successful transplantation and a control group of 14 patients with early rejection of the pancreas graft but functioning kidney graft were examined in a prospective study for 3 yr. Before transplantation, all patients had long-standing type I diabetes with advanced secondary complications, including end-stage diabetic nephropathy. After transplantation in the patients of both groups, kidney function was almost normal. Mean HbA1 levels were normal in the group with pancreas graft survival. In the control group, HbA1 levels were, on average, 1.5% higher compared with the group with pancreas survival (P = 0.00005). After 3 yr, the patients with functioning pancreas graft showed fewer symptoms (mean difference 1.0 in a symptom score ranging from 0 to 16, P = 0.004) compared with the control group. No statistically significant difference between both groups concerning clinical signs of polyneuropathy could be observed. In the pancreas and kidney transplantation group, peroneal and median nerve conduction velocities increased 7.2 m/s (P < 0.01) and 3.5 m/s (P < 0.05), respectively, whereas no increase was registered in the control group. The change of median and sural sensory nerve conduction velocities, peroneal and median compound muscle action potentials, and sural and median sensory action potentials was insignificant. In conclusion, although the improvement of clinical symptoms and neurophysiological signs of polyneuropathy was modest in the pancreas and kidney transplantation group, our data suggest that successful pancreas transplantation is able not only to halt the progression of diabetic polyneuropathy but also to improve it to some extent even at a far advanced stage.

Long‐term effects of pancreatic transplantation on diabetic neuropathy

“…The tendency for improvement of polyneuropathy shown in smaller numbers of patients followed from 1 to 4 years after PTx [27][28][29][30][31][45][46][47] is confirmed and given greater significance by this larger, long-term longitudinal study.…”

Amelioration of nerve conduction velocity following simultaneous kidney/pancreas transplantation is due to the glycaemic control provided by the pancreas

“…In these reports, neuropathy showed a continuous improvement in kidney and pancreas transplanted patients. However, it has been reported that neurophysiological tests tend to worsen in a control group of IDDM nontransplanted patients, or stabilise after an initial improvement in diabetic kidney transplanted patients or show no improvement in kidney and pancreas transplanted patients with early rejection of the pancreas [3,[7][8][9]. In order to discriminate between the contribution of the two grafted organs on nerve function, the ideal control group would be represented by kidney and pancreas grafted patients with functioning pancreas graft but failure of the kidney transplant.…”

Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation

“…So far, only a functioning pancreatic graft is able to normalize the blood glucose regulation over a long period. Positive effects of a long-term blood glucose normalization on diabetic secondary complications have been reported especially for diabetic sensory-motor polyneuropathy [21][22][23][24], autonomic neuropathy [23][24][25] and diabetic nephropathy [20,26,27]. There have also been reports on an improvement of the skin microcirculation measured by laser Doppler fluxmetry [28], laser speckle method [29], intravital capillaroscopy [28,30], telethermography [31] and transcutaneous oxygen tension measurement [29,31].…”