title: Stabilisation of diabetic retinopathy following simultaneous pancreas and kidney transplant.
abstract: OBJECTIVE
  Simultaneous pancreas and kidney transplantation (SPK) has become an important option in selected IDDM patients with end stage renal disease (ESRD). Successful SPK transplants are associated with long term normoglycaemic control and improved quality of life. However, debate still continues on the benefit to patients in terms of stabilisation or amelioration of diabetic retinopathy. The progression of diabetic retinopathy (DR) in a cohort of 20 SPK transplant patients is reported.
  
  
  METHODS
  All patients were reviewed postoperatively with corrected visual acuity, slit lamp examination, and fundal biomicroscopy. Preoperative data were collected retrospectively and DR was considered unstable if there had been a drop in Snellen acuity greater than three lines or a need for laser photocoagulation or vitrectomy in the 2 years preoperatively.
  
  
  RESULTS
  20 patients who received SPK transplants between March 1983 and April 1994 were reviewed (mean age 35.1 years; mean duration of IDDM = 24.6 years). 17 patients still had functioning grafts at a mean follow up of 5.1 years. Nine of these patients had unstable DR before transplantation. Of these, 89% (8/9) had stabilised DR following transplantation with only a single case requiring laser photocoagulation. Of the eight patients that had stable DR before transplantation all had stable DR following transplantation. 41% of cases (7/17) required cataract surgery during the follow up period.
  
  
  CONCLUSIONS
  Advanced diabetic retinopathy is present in a high proportion of cases managed with SPK transplant as a consequence of the duration of IDDM and the presence of ESRD. More than 90% of cases have stable DR following transplant.
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP.
authors.forename: I A
authors.initials: IA
authors.lastname: Pearce
authors.forename: B
authors.initials: B
authors.lastname: Ilango
authors.forename: R A
authors.initials: RA
authors.lastname: Sells
authors.forename: D
authors.initials: D
authors.lastname: Wong
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D002386:Cataract / Q000139:chemically induced*; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D013256:Steroids; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids