[Frontiers in Bioscience 2, e34-40, August 1, 1997]|
PANCREAS TRANSPLANTATION: INDICATIONS, CLINICAL MANAGEMENT, AND OUTCOMES
John P. Leone, MD, PhD1, Abhinav Humar1 , Rainer W. G. Gruessner, MD, PhD2, and David E.R. Sutherland, MD3
1Transplant Fellow, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, 2Professor & Chief, Section of Pancreatic Transplantation, Department of Surgery University of Minnesota, Minneapolis, Minnesota, 3Professor & Chief, Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Received 6/15/97; Accepted 6/23/97; On-line 7/25/97
9. EFFECTS ON COMPLICATIONS OF DIABETES
Studies evaluating the effects of pancreas transplantation on the secondary complications of diabetes have demonstrated variable results. With respect to retinopathy, data from our center determined that retinopathy was advanced in most recipients and that visual defects progressed within the first three years after transplant in about 30% of patients whether or not the pancreas graft continued to function (29). However, after three years, retinopathy stabilized as long as the graft continued to function. As expected, if the graft failed, retinopathy was likely to progress. A later study from the University of Wisconsin compared several parameters of diabetic retinopathy in SPK recipients and recipients of isolated kidney allografts (30). Their results showed significant improvement of retinopathy in SPK patients. However, those recipients with advanced retinopathy at the time of transplantation did not show improvement or early stabilization. Other studies show subjective improvement of neurological deficits, however, these findings do not correlate with quantitative measurements of nerve conduction (31-33). Difficulty arises when attempting to distinguish the effects on nerve conduction of improved glucose control verses improved creatinine clearance in SPK recipients. Additional reports on SPK patients show dramatic subjective but not quantitative improvement in autonomic neuropathy and gastroparesis (33,34). Functioning pancreas transplants stabilize diabetic glomerular nephropathy in native kidneys and prevent the recurrence of renal microvascular changes in renal allografts (35). However, cyclosporin and tacrolimus have nephrotoxic side-effects and thus, chronic glomerular damage can still occur. Improvements in the peripheral microvascular disease of pancreas allograft recipients are also difficult to evaluate (36). Enhanced skin perfusion has been demonstrated by laser studies, however, a decrease in skin ulceration or the need for amputation has yet to be shown.