title: Severe Epidermal Nerve Fiber Loss in Diabetic Neuropathy Is Not Reversed by Long-Term Normoglycemia After Simultaneous Pancreas and Kidney Transplantation.
abstract: Whether nerve fiber loss, a prominent feature of advanced diabetic neuropathy, can be reversed by reestablishment of normal glucose control remains questionable. We present 8-year follow-up data on epidermal nerve fiber (ENF) density and neurological function in patients with type 1 diabetes after simultaneous pancreas and kidney transplantation (SPK) with long-term normoglycemia. Distal thigh skin biopsies with ENF counts, vibration perception thresholds (VPTs), autonomic function testing (AFT) and electrophysiological examinations were performed at time of SPK and 2.5 and 8 years after SPK in 12 patients with type 1 diabetes. In comparison to controls, baseline ENF density, VPT and AFT results of patients indicated severe neuropathy. At follow-up, all SPK recipients were insulin independent with excellent glycemic control and kidney graft function; however, the severe ENF depletion present at baseline had not improved, with total ENF absence in 11 patients at 8-year follow-up. Similarly, no amelioration occurred in the VPT and AFT results. Numerical improvement was seen in some electrophysiological parameters; however, statistical significance was achieved only in median motor nerve conduction velocity. ENF loss and functional deficits in advanced diabetic peripheral neuropathy are rarely reversible, even by long-term normoglycemia, which underscores the importance of neuropathy prevention by early optimal glycemic control.
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Havrdova
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Boucek
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: F
authors.initials: F
authors.lastname: Saudek
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: L
authors.initials: L
authors.lastname: Voska
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Lodererova
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Üçeyler
authors.affiliation: Department of Neurology, Thomayer Hospital, Prague, Czech Republic.
authors.forename: H
authors.initials: H
authors.lastname: Vondrova
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Skibova
authors.affiliation: Diabetes and Transplant Centers, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: K
authors.initials: K
authors.lastname: Lipar
authors.affiliation: Department of Neurology, University of Würzburg, Würzburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Sommer
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D012867:Skin / Q000294:innervation* / Q000473:pathology
keywords: clinical research/practice; diabetes: secondary complications; diabetes: type 1; endocrinology/diabetology; neurology; pancreas/simultaneous pancreas-kidney transplantation