title: Increased weakness after pancreas and kidney transplantation.
abstract: BACKGROUND
  Already there is evidence that simultaneous pancreas and kidney (SPK), or pancreas after kidney (PAK) transplantation, in patients with type 1 diabetes mellitus and end-stage kidney disease prevents worsening of diabetic polyneuropathy, but neuropathic improvement is delayed and incomplete.
  
  
  METHODS
  In 85 patients with type 1 diabetes mellitus who underwent SPK or PAK transplantations, we performed sequential neuromuscular evaluations before, every 3 months after, and yearly after transplantation, quantitating muscle weakness separately from overall severity of polyneuropathy.
  
  
  RESULTS
  We found that, on average, the weakness subscore of the Neuropathy Impairment Score of the lower limbs [NIS(LL)-W] was significantly worse at 3, 6, 9, and 12 months (by about 5 points) than at baseline. By contrast, for these times after transplantation, a composite score of nerve conduction abnormalities, an independent measure of severity of polyneuropathy, was not significantly worse and, in fact, was significantly improved. In multivariate analysis, length of hospital stay correlated with the increased weakness.
  
  
  CONCLUSIONS
  We conclude that: (1) increased neuromuscular impairment after transplantation is mainly due to muscle weakness and not to worsening polyneuropathy; (2) in multivariate analysis, duration of hospitalization after transplantation was significantly associated with this increased weakness; (3) increased weakness is probably due to development of myopathy, which may be related to graft rejection, immunosuppression, sepsis, and intercurrent infections; (4) in future transplantation trials, weakness should be evaluated separately from neuropathic status, and the lowest efficacious dosages of immunotherapy should be used; and (5) essentially all diabetic patients reported that SPK or PAK transplantation was worthwhile because it freed them from diabetic lifestyle concerns.
authors.affiliation: Peripheral Neuropathy Research Center, Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester MN 55905, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Dyck
authors.forename: J A
authors.initials: JA
authors.lastname: Velosa
authors.forename: J M
authors.initials: JM
authors.lastname: Pach
authors.forename: S
authors.initials: S
authors.lastname: Sterioff
authors.forename: T S
authors.initials: TS
authors.lastname: Larson
authors.forename: J E
authors.initials: JE
authors.lastname: Norell
authors.forename: P C
authors.initials: PC
authors.lastname: O'Brien
authors.forename: P J
authors.initials: PJ
authors.lastname: Dyck
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004576:Electromyography; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018908:Muscle Weakness / Q000209:etiology*; D009431:Neural Conduction; D016035:Pancreas Transplantation / Q000009:adverse effects*; D017060:Patient Satisfaction; D011446:Prospective Studies