The success rate of Pancreas transplantation allows us to study in more detail the potential beneficial effects of normoglycemia on secondary complications in diabetes mellitus. We report a prospective follow-up (mean 26 mo) of metabolic control, neuropathy, retinopathy, and peripheral microcirculation in 31 patients with type I (insulin-dependent) diabetes (mean age 33 ± 1 yr; mean duration of diabetes 21 ± 1 yr) after combined kidney and segmental pancreas grafting. All patients had normal HbA1 levels. Glucose tolerance (GT), insulin, C-peptide, and glucagon were normal in 22 patients, and impaired oral GT with reduced insulin secretory capacity was seen in 9 patients. During follow-up, there was no deterioration of GT and insulin release. Vascular risk factors, e.g., hypertension, cholesterol, and triglycerides, decreased after grafting. Autonomic neuropathy improved clinically, and R-R variation increased significantly in 3 of 18 patients. Peripheral neuropathy improved clinically in 46% of patients and did not deteriorate in the others. Motor nerve conduction velocity increased >20% in 8, <20% in 12, and was unchanged in 8 of 28 recipients. Most of the patients (n = 30) had pretransplant laser treatment of their advanced retinopathy. Posttransplant visual acuity improved at least more than one line in 56%, stabilized in 32%, and deteriorated in 12% of patients. Patients with functioning grafts for >1 yr had no further deterioration of visual acuity. Vitreous hemorrhage frequency and severity dropped markedly from pretransplant (from 69 to 24%) 10 mo after grafting. Retinal morphology remained stable in all eyes except two. Peripheral microcirculation judged by telethermography and transcutaneous oxygen pressure markedly increased 6 mo posttransplant. We conclude that pancreas-kidney transplantation may lead to an improvement in quality of life and that it may ameliorate or at least stabilize some of the far-advanced diabetic secondary complications.
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Clinical Pancreas Transplantation|
January 01 1989
Fate of Late Complications in Type I Diabetic Patients After Successful Pancreas-Kidney Transplantation
Rüdiger Landgraf;
Rüdiger Landgraf
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Johann Nusser;
Johann Nusser
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Wolfgang Müller;
Wolfgang Müller
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Martina MC Landgraf-Leurs;
Martina MC Landgraf-Leurs
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Stefan Thurau;
Stefan Thurau
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Michael Ulbig;
Michael Ulbig
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Anselm Kampik;
Anselm Kampik
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Bernhard Lachenmayr;
Bernhard Lachenmayr
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Günther Hillebrand;
Günther Hillebrand
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Stefan Schleibner;
Stefan Schleibner
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Wolf-Dieter Illner;
Wolf-Dieter Illner
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Dietmar Abendroth;
Dietmar Abendroth
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Walter Land
Walter Land
Department of Internal Medicine “Innenstadt,” the Department of Ophthalmology, and the Transplantation Center, University of Munich
Munich, Federal Republic of Germany
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Address correspondence and reprint requests to Dr. R. Landgraf, Department of Internal Medicine “Innenstadt,” University of Munich, Ziemssenstr.1, D-8000 Munich 2, FRG
Citation
Rüdiger Landgraf, Johann Nusser, Wolfgang Müller, Martina MC Landgraf-Leurs, Stefan Thurau, Michael Ulbig, Anselm Kampik, Bernhard Lachenmayr, Günther Hillebrand, Stefan Schleibner, Wolf-Dieter Illner, Dietmar Abendroth, Walter Land; Fate of Late Complications in Type I Diabetic Patients After Successful Pancreas-Kidney Transplantation. Diabetes 1 January 1989; 38 (Supplement_1): 33–37. https://doi.org/10.2337/diab.38.1.S33
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