Spectral Analysis of Heart Rate Variation Following Simultaneous Pancreas and Kidney Transplantation

Bouc̆ek, P; Saudek, F; Adamec, M; Janoušek, L; Kožnarová, R.; Havrdova, T.; Skibová, J

doi:10.1097/00007890-200308271-00076

Cited by 7 publications

(11 citation statements)

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“…Pancreas transplantation has previously been shown to improve large nerve fiber conduction and, in particular, upper limb motor and sensory action potentials as well as sudomotor function within 1 year (13), but no impact on autonomic function was seen (13,14). Our studies show no relationship between quantitative sensory tests evaluating small fiber function and unmyelinated fiber pathology (9).…”

Section: After Transplantationmentioning

confidence: 45%

“…For diabetic neuropathy, the largest and longest follow-up series to date has shown that pancreas transplantation improved both motor and sensory nerve conduction as well as sudomotor function in the hand and foot within 1 year, which was maintained throughout follow-up for 10 years (13,25). However, autonomic function did not improve (13), as confirmed by another recent study (14). At this stage, most patients receiving transplantation will have severe nerve fiber damage as evidenced by marked depletion of intraepidermal nerve fibers (15).…”

Section: After Transplantationmentioning

confidence: 73%

“…Even in the most dramatic example of "curing" type 1 diabetes with pancreas transplantation, in 115 patients followed over 10 years, neurological function, nerve conduction studies, and autonomic function were only prevented from worsening and failed to show an improvement (13). This result is in keeping with the lack of improvement in heart rate variability 43 months after simultaneous pancreas and kidney transplantation (SPK) (14). Neuropathy is, of course, extremely severe at this stage, as evidenced recently by the demonstration of severe intraepidermal nerve fiber depletion in pancreas transplant recipients, suggesting that long-term follow-up is necessary to assess posttransplant nerve fiber regeneration (15).…”

mentioning

confidence: 81%

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Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes

et al. 2007

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OBJECTIVE -Corneal confocal microscopy (CCM) is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber pathology. We have used it to assess the neurological benefits of pancreas transplantation in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-In 20 patients with type 1 diabetes undergoing simultaneous pancreas and kidney transplantation (SPK) and 15 control subjects, corneal sensitivity was evaluated using noncontact corneal esthesiometry, and small nerve fiber morphology was assessed using CCM.RESULTS -Corneal sensitivity (1.54 Ϯ 0.28 vs. 0.77 Ϯ 0.02, P Ͻ 0.0001), nerve fiber density (NFD) (13.8 Ϯ 2.1 vs. 42 Ϯ 3.2, P Ͻ 0.0001), nerve branch density (NBD) (4.04 Ϯ 1.5 vs. 26.7 Ϯ 2.5, P Ͻ 0.0001), and nerve fiber length (NFL) (2.23 Ϯ 0.2 vs. 9.69 Ϯ 0.7, P Ͻ 0.0001) were significantly reduced, and nerve fiber tortuosity (NFT) (15.7 Ϯ 1.02 vs. 19.56 Ϯ 1.34, P ϭ 0.04) was increased in diabetic patients before pancreas transplantation. Six months after SPK, 15 patients underwent a second assessment and showed a significant improvement in NFD (18.04 Ϯ 10.48 vs. 9.25 Ϯ 1.87, P ϭ 0.001) and NFL (3.60 Ϯ 0.33 vs. 1.84 Ϯ 0.33, P ϭ 0.002) with no change in NBD (1.38 Ϯ 0.74 vs. 1.38 Ϯ 1.00, P ϭ 1.0), NFT (15.58 Ϯ 1.20 vs. 16.30 Ϯ 1.19, P ϭ 0.67), or corneal sensitivity (1.23 Ϯ 0.39 vs. 1.54 Ϯ 00.42, P ϭ 0.59).CONCLUSIONS -Despite marked nerve fiber damage in type 1 diabetic patients undergoing pancreas transplantation, small fiber repair can be detected within 6 months of pancreas transplantation using CCM. CCM is a novel noninvasive clinical technique to assess the benefits of therapeutic intervention in human diabetic neuropathy. Diabetes Care 30:2608-2612, 2007S omatic polyneuropathy is one of the most common long-term complications of diabetes and is the main initiating factor for foot ulceration and lower extremity amputation (1,2). As 80% of amputations are preceded by foot ulceration, an effective means of detecting and treating peripheral neuropathy would have a major medical, social, and economic impact. With the exception of optimal glycemic control, there are currently no licensed treatments that prevent, slow, or arrest the development of neuropathy (1). The development of new treatments is of paramount importance, but they are hampered by a lack of clinically relevant surrogate end points favored by regulatory authorities (1). We have relied on tests that quantify predominantly large nerve fiber dysfunction, which were principally developed to aid diagnosis and not to assess nerve repair and hence a therapeutic response (3). Thus, nerve conduction studies are useful but only detect an abnormality in large myelinated nerve fibers, whereas thermal and pain thresholds assess thinly myelinated (A␦) and unmyelinated (C) fiber function. Heart rate variability during respiratory stimuli indicates parasympathetic vagal efferent function, and blood pressure change during orthostatic manipulation evaluates sympathetic vasomotor efferents.Although these tests correlate with axonal los...

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Section: After Transplantationmentioning

confidence: 45%

Section: After Transplantationmentioning

confidence: 73%

mentioning

confidence: 81%

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Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes

et al. 2007

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“…On the other hand, most studies have failed to detect any beneficial effect of PT on cardiorespiratory reflex testing, i.e. on functions mediated by small nerve fibers [39,40].…”

Section: Clinical Datamentioning

confidence: 99%

Advanced Diabetic Neuropathy: A Point of no Return?

Bouc̆ek¹

2006

Rev Diabetic Stud

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■ AbstractDiabetic peripheral neuropathy is the most common complication of long-standing diabetes mellitus which frequently results in clinically significant morbidities e.g. pain, foot ulcers and amputations. During its natural course it progresses from initial functional changes to late, poorly reversible, structural changes. Various interconnected pathogenetic concepts of diabetic neuropathy have been proposed based on metabolic and vascular factors, mostly derived from long-term hyperglycemia. These pathogenetic mechanisms have been targeted in several experimental and clinical trials. This review summarizes available, mainly morphological data from interventions designed to halt the progression or achieve the reversal of established diabetic neuropathy, which include the recovery of normoglycemia by pancreas or islet transplantation, polyol pathway blockade by aldose reductase inhibitors, mitigation of oxidative stress by the use of antioxidants or correction of abnormalities in essential fatty acid metabolism. Unfortunately, to date, no treatment based on pathogenic considerations has shown clear positive effects and thus early institution of optimal glycemic control remains the only available measure with proven efficacy in preventing or halting progression of diabetic neuropathy. Further experimental and clinical research employing objective reproducible parameters is clearly needed. Novel noninvasive or minimally invasive methods e.g. corneal confocal microscopy or epidermal nerve fiber counts may represent potentially useful instruments for the objective assessment of nerve damage and monitoring of treatment effects.

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“…Autonomic diabetic neuropathy was studied in 29 SPKTx recipients pre-and post-transplant using standard Ewing battery and spectral heart rate variation. In this group of recipients suffering from advanced forms of neuropathy, significant improvements were observed, although subjective symptoms seemed to be much better in the group of patients with functioning pancreatic grafts [5].…”

Section: Effect Of Pancreas Transplantation On Diabetic Retinopathy Amentioning

confidence: 73%

The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010

Girman

Saudek²

2011

Rev Diabet Stud

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■ AbstractCurrently, 25-30 pancreas transplantations per year are carried out in type 1 diabetes (T1D) recipients residing in Czech Republic. Most of the recipients are transplanted together with kidney allografts, but pancreas is also transplanted alone in selected patients with brittle diabetes. Since 2005, the Institute for Clinical and Experimental Medicine (IKEM) islet transplant program was initiated as complementary therapeutic modality. The aim of this paper was to analyze the transplant program at our clinical center, and to examine the survival of recipients, and their pancreas, kidney, and islet grafts. Patient and graft survival rates were evaluated in the following three categories using KaplanMeier test: simultaneous pancreas and kidney transplantation (SPKTx), pancreas transplantation alone (PTA), and islet transplantation (ITx). Three hundred and ninety SPKTx, 34 PTA and 44 ITx were carried out between 1983 and 2010. One-and 5-year patient survival rates were 92 % and 81% in SPKTx, respectively. In SPKTx, the 1-year survival rate of pancreas grafts was 78%, and the 5-year rate was 66%. Kidney graft survival rates were 89% and 79%, respectively, after the same follow-up periods. In the PTA category, recipient survivals were 100% after 1 year, and 92% after 3 years. 70% and 65% of pancreatic grafts were working properly at 1 and 3-year follow-ups, respectively. To date, we have carried out 44 islet transplantations in 31 recipients. Islet function (C-peptide ≥ 0.2 ng/ml) was documented in 60% of recipients after 12 months. So far, only 3 patients remained free of exogenous insulin. While SPKTx is a well established treatment for uremic T1D patients, ITx represents an emerging complementary treatment modality. The latter is especially suitable for high-risk recipients, but routine clinical application is still hampered by the limited availability of usable organ transplants and viability of transplanted islets.

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Spectral Analysis of Heart Rate Variation Following Simultaneous Pancreas and Kidney Transplantation

Cited by 7 publications

References 0 publications

Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes

Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes

Advanced Diabetic Neuropathy: A Point of no Return?

The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010

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