Diabetic retinopathy and pancreas transplantation: a 3-year follow-up

Abstract

The effect of simultaneous pancreas and kidney transplantation on diabetic retinopathy was studied in a prospective study with 30 patients (57 eyes) and 15 control subjects (26 eyes), patients who lost the pancreas, but preserved kidney function. There was no significant difference between the groups after a mean observation time of more than 35 months (a range of 12 to 96 months). Both populations had a stable retinopathy during follow-up. This seems to be a consequence of the far advanced retinopathy (mean duration of type 1 diabetes was 22 years) and the high percentage of coagulated eyes (81% and 85%, respectively), but is not related to the organ transplantation. A closer look at the few patients who did not receive laser coagulation (14 patient and 6 control eyes), produced a different result. Four control eyes experienced a significant deterioration of the retinopathy which had been stable before rejection. It is the most important and so far never mentioned aspect of this study, that periods of destabilisation are a definite threat for the retinopathy. Nevertheless, it seems questionable whether we will ever be able to make a definite statement on the pancreas-eye relation, as long as the transplantation must be restricted to carefully selected late-stage diabetic subjects.

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

“…However, many patients still progress to more severe lesions despite improvements in glucose control [4]. After blood glucose normalisation subsequent to simultaneous pancreas-kidney transplantation, a few groups (but not all) observed amelioration of diabetes ocular complications [6][7][8][9][10][11][12][13][14], but it cannot be ruled out that the attendant cure of uraemia might have played an important role [25]. Therefore, studying normoglycaemic pancreas-alone recipients is possibly a better way to assess the effects of normoglycaemia on diabetes complications.…”

“…Lately, the effects of combined pancreas-kidney transplantation on diabetic retinopathy have been described, and conflicting results reported [6][7][8][9][10][11][12][13][14]. Some work showed no significant change or even progression in retinal complications following combined pancreas-kidney transplantation [6][7][8][9].…”

“…Some work showed no significant change or even progression in retinal complications following combined pancreas-kidney transplantation [6][7][8][9]. In addition, an increased prevalence of posttransplant cataract has also been observed [15].…”

Pancreas Transplantation: Solid Organ and Islet

“…However, in order to establish the real effect of transplantation on vision, a large prospective study involving longitudinal retinal images and a relevant control group will be necessary. It has been suggested that rejection episodes may have a deleterious effect on retinopathy, causing sudden deterioration (Scheider et al 1991). In addition, the increased risk of cataracts following transplantation must also be considered.…”

Transplante de pâncreas e ilhotas em portadores de diabetes melito

“…O TSPR está associado à estabilização da RD em 73,3% dos pacientes, em comparação com 54% nos casos em que houve perda do enxerto pancreático (59), além da melhora na microcirculação conjuntival em comparação aos pacientes diabéticos não-transplantados e os pacientes diabéticos transplantados renais (60). No entanto, outros autores não relataram diferença na estabilização da retinopatia entre os pacientes com enxerto pancreático funcionante ou não, especialmente quando a retinopatia encontra-se avançada na ocasião do transplante (61). Nos dados da Universidade Federal de São Paulo (Unifesp), a piora da retinopatia no primeiro ano do transplante esteve associada ao valor do clearance da creatinina, não sendo identificados fatores de risco após o primeiro ano.…”