Diabetic retinopathy after combined kidney-pancreas transplantation

Diabetic retinopathy (DR) is amenable to good diabetic control; however, on ly successful pancreas transplantation can achieve sustained normoglycaemia . The aim of this long-term study was to examine the course of DR in insuli n-dependent diabetic recipients of a simultaneous kidney and pancreas trans plant (SPK). Successful SPK recipients (n = 46) and failed pancreas transpl ant with a functioning kidney transplant (n = 8) were assessed by baseline and regular posttransplant ophthalmic examinations (n = 432) for up to 10 y r after SPK. At the time of SPK (n = 108 eyes), the mean duration of diabet es was 25 +/- 7 yr, ten eyes were blind, and 79% of eyes had advanced DR th at had panretinal laser (panretinal photocoagulation, PRP). Successful SPK recipients had normal glucose control with a mean HBA(1)C of 5.2 +/- 0.6%. DR remained stable in 75% of both the study and control groups, with no dif ference between groups. The DR mostly evolved towards inactive proliferativ e DR. After SPK, 14% of non-blind eyes showed improvement of DR, 76% remain ed stable and 10% progressed. Early vitreous haemorrhage occurred in 6.1'% of eyes, and was related to established DR. Cataract of all types increased after transplantation (p < 0.01), which reduced visual acuity (VA) in affe cted eyes. The mean overall VA remained unchanged for the study duration. I n summary, uremic patients from diabetic nephropathy had a high prevalence of severe proliferative DR and blindness at the time of presentation for SP K. This was subsequently stabilised to inactive proliferative DR by appropr iate laser therapy followed by metabolic control achieved by SPK.