Blood flow in the skin of type 1 diabetic patients before and after combined pancreas/kidney transplantation.
BACKGROUND
To analyze effects of long-term glucose normalization after pancreas transplantation, different parameters of skin microcirculation were assessed by laser Doppler fluxmetry.


METHODS
Forty-two type 1 diabetic patients after successful simultaneous pancreas/kidney transplantation (Group A, median 32.3 months posttransplant), 28 patients with functioning kidney grafts, but insulin therapy (Group B, median 64.9 months posttransplant) and 13 diabetic pretransplant patients (Group C, median 14.2 months on dialysis) were compared with 33 healthy subjects (Group D). Resting blood flow, postocclusive hyperemia, venoarteriolar response on the right foot and decrease in blood flow during cold pressure test on the left finger was assessed.


RESULTS
Postocclusive hyperemia, decrease in blood flow during cold pressure test and venoarteriolar response were higher in Group D than in all patient groups. Resting blood flow in Group A was significantly lower than in Groups B and C (following values as median): 3.6 perfusion units (PU) versus 7.4 PU in Group B, p < 0.01 and 12.1 PU in Group C, p < 0.001, respectively, and was not significantly different to controls (Group D, 5.2 PU). Postocclusive hyperemia was higher in Group A than in Groups B and C (266.7% vs 160.0%, p < 0.05 and 79.4% n.s., respectively), but significantly less than in Group D (563.5%). The microangiopathy index-high values reflecting less or no microangiopathy-was significantly higher in Group A than in Groups B and C (11.0 vs 4.3, p < 0.001 and 4.7, p < 0.05, respectively), and was very much comparable to the values in healthy controls (Group D, 10,3). The decrease in blood flow during cold pressure test was higher in Group A compared to Groups B and C (25.2% vs 21.1% and 13.8%, n.s., respectively), but much less than in Group D (65,7%).


CONCLUSIONS
These data suggest an improvement without complete normalization of skin microcirculation by long-term blood glucose normalization achieved by pancreas transplantation.
Eberl
Nicola
N
Department of Internal Medicine Innenstadt, University of Munich, Germany. mediger.landgraf@med.uni-muenchen.de
Piehlmeier
Wolfgang
W
Dachauer
Stefan
S
König
August
A
Land
Walter
W
Landgraf
Rüdiger
R
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000503:physiopathology; D005260:Female; D005385:Fingers; D005528:Foot; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000502:physiology; D012039:Regional Blood Flow; D012867:Skin / Q000098:blood supply*; D012881:Skin Temperature
D007328:Insulin