Beneficial effect of pancreas and kidney transplantation on advanced diabetic retinopathy.
In pancreas recipients with advanced diabetic eye disease, conflicting ophthalmologic results over different follow-up periods have been reported. In the present prospective study we performed ophthalmologic evaluation groups of type I diabetic patients: 1) normoglycemic recipients of pancreas and kidney grafts (group SPK, n = 43, follow-up 44.9 +/- 35.1 months), 2) pancreas and kidney graft recipients with nonfunctioning pancreatic graft, and recipients of isolated kidney graft (group K, n = 45, follow-up 60.3 +/- 34.2 months). The examinations were performed before transplantation, at the end of follow-up (at least 1 year), and in 63 recipients also at 3 years posttransplant. Visual acuity results at baseline and at the end of follow-up were 0.48 +/- 0.39 vs. 0.50 +/- 0.39 in the SPK group, and 0.46 +/- 0.38 vs. 0.40 +/- 0.39 in the K group. While intragroup changes were not significant, the changes were significantly different between the groups (p < 0.05). Fundoscopic findings at the end of follow-up were improved, stabilized, or deteriorated in the SPK group in 21.3%, 61.7%, and 17.0%, respectively. The respective figures for the K group were 6.1%, 48.8%, and 45.1% (p < 0.001). Similar results were obtained when evaluating findings at 3 years posttransplant. Before transplantation, 78% of the SPK group and 81% of the K group had been treated by laser. The need for additional posttransplant laser therapy was significantly lower in the SPK (31%) than in the K group (58%; p < 0.001). In conclusion, pancreas transplant exerts a beneficial effect on the course of diabetic retinopathy even in its late stage.
Koznarová
R
R
Institute for Clinical and Experimental Medicine, Diabetes Center, Prague, Czech Republic. radomira.koznarova@medicon.cz
Saudek
F
F
Sosna
T
T
Adamec
M
M
Jedináková
T
T
Boucek
P
P
Bartos
V
V
Lánská
V
V
D000328:Adult; D002386:Cataract / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003930:Diabetic Retinopathy / Q000628:therapy*; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000601:surgery; D015994:Incidence; D016030:Kidney Transplantation; D008875:Middle Aged; D016035:Pancreas Transplantation; D011446:Prospective Studies; D014792:Visual Acuity
D006442:Glycated Hemoglobin