Follow-up study of sensory-motor polyneuropathy in Type 1 (insulin-dependent) diabetic subjects after simultaneous pancreas and kidney transplantation and after graft rejection
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The influence of successful simultaneous pancreas and kidney transplantation on peripheral polyneuropathy was investigated in 53 patients for a mean observation period of 40.3 months. Seventeen patients were followed-up for more than 3 years. Symptoms and signs were assessed every 6 months using a standard questionnaire, neurological examination and measurement of sensory and motor nerve conduction velocities. While symptoms of polyneuropathy improved (pain, paraesthesia, cramps, restless-legs) and nerve conduction velocity increased, there was no change of clinical signs (sensation, muscle-force, tendon-reflexes). Following kidney-graft-rejection there was a slight decrease of nerve conduction verlocity during the first year, which was not statistically significant. Following pancreas-graft rejection there was no change of nerve conduction velocity during the first year. Comparing the maximum nerve conduction velocity of the patients with pancreas-graft-rejection to the nerve conduction velocities of these patients at the end of the study, there was a statistically significant decrease of 6.5 m/s.
In conclusion, we believe that strict normalization of glucose metabolism alters the progressive course of diabetic polyneuropathy. It may be stabilized or partly reversed after successful grafting even in long-term diabetic patients.
Key wordsPolyneuropathy Diabetes mellitus Pancreas transplantation Kidney transplantation
- American Diabetes Association (1988): Report and recommendations of the San Antonio conference on diabetic neuropathy. Muscle and Nerve 11: 661–667Google Scholar
- Boulton A.J.M., Scarpello J.H.B., Armstrong W. D., Ward J.D. (1983): The natural history of painful diabetic neuropathy- a 4 year study. Postgraduate Medical J. 59: 556–559Google Scholar
- Dyck P.J., Brown M., Greene D. (1986): Does improved control of glycaemia prevent or ameliorate diabetic polyneuropathy ? Ann. Neurol. 19: 288–293Google Scholar
- Kennedy R.W., Navarro X., Goetz F.C., Sutherland D.E., Najarian S. (1990): Effects of pancreatic transplantation on diabetic neuropathy. N Engl J of Med 322: 1031–1037Google Scholar
- Land W., Landgraf R., Illner W, Abendroth D., Kampik A., Jensen U., Lenhart F.P., Burg D., Hillebrand, G., Castro LA, Landgraf-Leurs MMC, Frey L., Gokel M., Schleibner H., Nusser J., Ulbig M. (1987): Clinical pancreatic transplantation using the prolamine duct occlusion technique- The Munich Experience. Transpl. Proc. 19 (Suppl. 4): 75–83Google Scholar
- Landgraf R, Landgraf-Leurs MMC, Kampik A., Burg D., Castro LA., Abendroth D., Illner WD., Land W. (1987): Pancreas transplantation as a mean for insulin replacement: An outlook. In: P. Brunetti, W.K. Waldhäusl (eds) Advanced Models for the Therapy of Insulin-Dependent Diabetes. Raven Press Vol. 37:395–400Google Scholar
- Solders G., Gunnarsson R., Persson A., Wilczek H., Tyden G., Groth C.G (1987): Effects of combined pancreatic and renal transplantation on diabetic neuropathy: a two-year follow-up study. The Lancet 333: 1232–1235Google Scholar
- Unger R.H. (1982): Meticulous control of diabetes: benefits, risks and precautions. Diabetes 31: 479–483Google Scholar
- Van der Vliet JA., Navarro X., Kennedy W.R., Goetz F.C., Najarian J.S., Sutherland D.E. (1988): The effect of pancreas transplantation on diabetic polyneuropathy. Transplantation 45: 368–370Google Scholar