End-stage renal failure in juvenile diabetes mellitus: a 5-year follow-up of treatment.
A group of 43 juvenile diabetic patients accepted for renal transplantation and followed up for as long as 5 years was studied. The cumulative survivial of the group was 66% at 1 year and 58% at 5 years. The 1-year survival of those receiving cadaveric renal allografts (65%) or of those on dialysis alone (55%) was less than the survival of those after living related donor transplantation (88%). The major morbid sequelae included retinopathy, neuropathy, and peripheral vascular disease. While patients were on dialysis, blindness increased, with 44% of the bilateral blindness and 27% of the unilateral blindness representing new cases. After transplantation, permanent unilateral or bilateral blindness developed in an additional 12% of the patients. Severe neuropathy progressed rapidly in patients on dialysis and improved after transplantation in all. Fifty percent of the patients who survived transplantation 1 year or more required amputation of one or more extremities. Only 25% of the patients who survived 1 year after transplantation were without blindness, severe peripheral vascular problems, or both.
D000293:Adolescent; D001766:Blindness / Q000209:etiology; D002102:Cadaver; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000534:rehabilitation / Q000628:therapy*; D003929:Diabetic Neuropathies; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis; D014184:Transplantation, Homologous; D014652:Vascular Diseases / Q000209:etiology