The effect of pancreatic islet transplantation on progression of diabetic retinopathy and neuropathy.
BACKGROUND
Pancreatic islet transplantation (PIT) has only become an effective treatment for type 1 diabetes mellitus within the past 4 years. As a result, the long-term effects of PIT on progression of diabetic neuropathy and retinopathy are unknown. The benefit of halting or improving diabetic neuropathy and retinopathy is of particular interest since most PIT recipients have not developed the advanced complications of diabetes. Herein, we describe the improvement and stabilization of diabetic neuropathy and retinopathy in 12 PIT recipients.


METHODS
Between January 1, 2002, and June 30, 2004, there have been 12 patients who have received PIT. Currently, there are eight patients who have sufficient follow-up to assess the progression of diabetic retinopathy and neuropathy. To assess for disease progression, patients were examined by a single ophthalmologist and single neurologist throughout the study period. Eye exams were performed using a slit-lamp exam while neurological status was assessed using electromyelograms and clinical exams.


RESULTS
All PIT recipients had decreases in hemoglobin A(1)C and increases in serum C-peptide. All study patients had stabilization of their retinopathic disease. One patient demonstrated improvement of retinopathy at 1 year posttransplant. Fifty percent of patients demonstrated improvement or stabilization of their diabetic neuropathy. One patient had mild reinnervation of the fingers and wrist extensors by clinical exam 1 year posttransplant. Four patients exhibited an average decrease of 19% in sural nerve conduction velocities.


CONCLUSIONS
Our series has demonstrated that all PIT recipients have had stabilization of their diabetic retinopathy and that 50% of patients exhibited stabilization or even improvement of their diabetic neuropathy.
Lee
T C
TC
Department of Surgery, Baylor College of Medicine, 6550 Fannin, Houston, TX 77030, USA.
Barshes
N R
NR
O'Mahony
C A
CA
Nguyen
L
L
Brunicardi
F C
FC
Ricordi
C
C
Alejandro
R
R
Schock
A P
AP
Mote
A
A
Goss
J A
JA
D000328:Adult; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000517:prevention & control*; D003930:Diabetic Retinopathy / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination
D002096:C-Peptide