Acta Univ. Palacki. Olomuc., Fac. Med. Volume 141, 1998

EFFECT OF SUCCESSFUL COMBINED RENAL AND PANCREATIC TRANSPLANTATION ON DIABETIC RETINOPATHY

Tomáš Sosna^a,b, František Saudek^a, Zdeněk Domínek^b

^a Department of Diabetes Study and Experimental Therapy, Institute for Clinical and Experimental Medicine, Vídeňská 800, 140 00 Prague 4, Czech Republic

^b Thomayer Teaching Hospital, Vídeňská 800, 140 00 Prague 4, Czech Republic

The treatment of diabetic retinopathy (DR) is one of the most challenging problems in ophthalmology. The possibility ofmodulating DR by successful combined kidney and pancreas transplantation thus holds an attractive promise for theophthalmologist.From June 1983 until April 1997, a total of 86 combined kidney and pancreas transplantation procedures were performedat the Prague-based Institute for Clinical and Experimental Medicine.All recipients are on close follow-up in terms of their ophthalmic status. However, evaluation of the effect of transplantationis problematic because of the advanced status of DR prior to the procedure.We divided the transplant recipients into two groups according to type of transplantation. In Group I (segmentaltransplantation), proliferative DR was present in 100% eyes, 70% had undergone vitrectomy, and there were 21% of blindeyes. All eyes had been treated by laser. In this group, long-term stabilization of the finding was observed in three patients.In Group II (whole pancreas transplantation), proliferative and non-proliferative DR was diagnosed in 86% and 14%,respectively. There were 12% of blind eyes, and 70% had been treated by laser prior to transplantation.After a successful transplantation, stabilization was found in 60%, improvement in 18%, and deterioration in 22% of eyesin this group. The stabilization and improvement can be explained by subsequent normoglycemia (HbAlc 5.6%). Bycontrast, we were unable to provide a satisfactory explanation for the deterioration and progression of these findings. Whilethe effect of immunosuppression on DR remains unclear, it obviously accelerates the existing cataract.

Conclusion: Successful combined transplantation has a beneficial effect on DR and is worthwhile even for patients at theend stage on account of its beneficial psychosocial effect and prevention of dolorous glaucoma. However, many effects ofthe procedure on the eye of diabetics remain to be identified in future studies.

Keywords: Pancreas, Kidney, Transplantation, Successful, Retinopathy

Published: July 1, 1998  Show citation