Diabetologia

, Volume 34, Supplement 1, pp S95–S99

Diabetic retinopathy and pancreas transplantation: a 3-year follow-up

  • A. Scheider
  • E. Meyer-Schwickerath
  • J. Nusser
  • W. Land
  • R. Landgraf
Retinopathy

Summary

The effect of simultaneous pancreas and kidney transplantation on diabetic retinopathy was studied in a prospective study with 30 patients (57 eyes) and 15 control subjects (26 eyes), patients who lost the pancreas, but preserved kidney function. There was no significant difference between the groups after a mean observation time of more than 35 months (a range of 12 to 96 months). Both populations had a stable retinopathy during follow-up. This seems to be a consequence of the far advanced retinopathy (mean duration of type 1 diabetes was 22 years) and the high percentage of coagulated eyes (81% and 85%, respectively), but is not related to the organ transplantation. A closer look at the few patients who did not receive laser coagulation (14 patient and 6 control eyes), produced a different result. Four control eyes experienced a significant deterioration of the retinopathy which had been stable before rejection. It is the most important and so far never mentioned aspect of this study, that periods of destabilisation are a definite threat for the retinopathy. Nevertheless, it seems questionable whether we will ever be able to make a definite statement on the pancreas-eye relation, as long as the transplantation must be restricted to carefully selected late-stage diabetic subjects.

Key words

Diabetes mellitus pancreas transplantation diabetic retinopathy 

References

  1. Bilous RW, Mauer SM, Sutherland DER, Steffes MW (1989) The effect of pancreas transplantation on the glomerular structure of renal allografts in patients with insulin-dependent diabetes. New England Journal of Medicine 321:80–85Google Scholar
  2. Bolinder J, Tyden G (1989) Indication, selection of patients and timing for pancreatic transplantation. Baillière's Clinical Gastronetreology 3:825–833Google Scholar
  3. Burger W, Weber B, Hartmann R, Hovener G (1986) Annual progression of retinopathy in conventionally treated children and adolescents with type I diabetes mellitus. Acta Endocrinol Suppl (Copenh)Google Scholar
  4. DRS (1987) Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. The Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin 27:239–53Google Scholar
  5. ETDRS (1987) Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology 94:761–74Google Scholar
  6. Klein R (1988) Discussion of: Landgraf, R. Landgraf-Leurs, M.M.C. Kampik, A. et al.: Pancreatic transplantaion as a means for prevention or treatment of late diabetic complications? Pediat. adolesc. Endocr. 17:235–243Google Scholar
  7. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL (1988) Glycosylated hemoglobin predicts the incidence and progression of diabetic retinopathy. Jama 260:2864–71Google Scholar
  8. Koerner F (1987) [Possibilities and limitations of photocoagulation treatment in diabetic retinopathy]. Ther Umsch 44:273–82Google Scholar
  9. Petersen MR, Vine AK, Committee TUoMPTE (1990) Progression of diabetic retinopathy after pancreas transplantation. Opthalmology 97:496–502Google Scholar
  10. Ramsay RC, Goetz FC, Sutherland DE, Mauer SM, Robison LL, Cantrill HL, Knobloch WH, Najarian JS (1988) Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. N Engl J Med 318:208–14Google Scholar
  11. Rosenlund EF, Haakens K, Brinchmann HO, Dahl JK, Hanssen KF (1988) Transient proliferative diabetic retinopathy during intensified insulin treatment. Am J Ophthalmol 105:618–25Google Scholar
  12. Scheider A, Thurau S, Ulbig M, Meyer-Schwickerath E (1989) Diabetic retinopathy remains stable after combined kidney and pancreas transplantation for type I diables mellitus. Diabetologica 32:538AGoogle Scholar
  13. Ulbig M, Kampik A, Landgraf R, Land W (1987) The influence of combined pancreatic and renal transplantation on advanced diabetic retinopathy. Transplant Proc 19:3554–3556Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • A. Scheider
    • 1
    • 4
  • E. Meyer-Schwickerath
    • 1
  • J. Nusser
    • 2
  • W. Land
    • 3
  • R. Landgraf
    • 2
  1. 1.Department of OphthalmologyLudwig-Maximilians-UniversityMunichGermany
  2. 2.Department of Internal Medicine InnenstadtLudwig-Maximilians-UniversityMunichGermany
  3. 3.Transplantation Center Klinikum GrosshadernLudwig-Maximilians-UniversityMunichGermany
  4. 4.Department of OphthalmologyUniversity of MunichMunich 2Germany

Personalised recommendations