Stabilisation of diabetic retinopathy following simultaneous pancreas and kidney transplant

Background/aims-Simultaneous pancreas and kidney transplantation (SPK) has become an important option in selected IDDM patients with end stage renal d isease (ESRD). Successful SPK transplants are associated with long term nor moglycaemic control and improved quality of life. However, debate still con tinues on the benefit to patients in terms of stabilisation or amelioration of diabetic retinopathy. The progression of diabetic retinopathy (DR) in a cohort of 20 SPK transplant patients is reported. Methods-AU patients were reviewed postoperatively with corrected visual acu ity, slit lamp examination, and fundal biomicroscopy. Preoperative data wer e collected retrospectively and DR was considered unstable if there had bee n a drop in Snellen acuity greater than three lines or a need for laser pho tocoagulation or vitrectomy in the 2 years preoperatively. Results-20 patients who received SPK transplants between March 1983 and Apr il 1994 were reviewed (mean age 35.1 years; mean duration of IDDM = 24.6 ye ars). 17 patients still had functioning grafts at a mean follow up of 5.1 y ears. Nine of these patients had unstable DR before transplantation. Of the se, 89% (8/9) had stabilised DR following transplantation with only a singl e case requiring laser photocoagulation. Of the eight patients that had sta ble DR before transplantation all had stable DR following transplantation. 41% of cases (7/17) required cataract surgery during the follow up period. Conclusions-Advanced diabetic retinopathy is present in a high proportion o f cases managed with SPK transplant as a consequence of the duration of IDD M and the presence of ESRD. More than 90% of cases have stable DR following transplant.