Successful pancreas transplantation (PT) alone reverses established lesions of diabetic nephropathy (D) in man
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:111A 1997
Mauer's laboratory, the source of the seminal observation that renal allografts from nondiabetic donors placed into recipients with diabetes will manifest typical diabetic nephropathy carries his probe of the environment surrounding renal transplants a key step further.
This abstract reports the long term follow-up of a previous study in which native renal histology of non-uremic patients diabetes was evaluated 5 years after successful pancreas transplant. In the original study, Mauer's group concluded: "Diabetic glomerular lesions in patients with their own kidneys were not ameliorated by pancreas transplantation, despite 5 years of normoglycaemia. Pancreas transplantation can correct severe metabolic instability and thus improve quality of life, but it cannot yet be recommended for the treatment of established lesions of diabetic nephropathy." Now, however, on further 10-year follow-up of 8 of the patients, who had repeat renal biopsies, a number of morphometric glomerular parameters such as mesangial volume, mesangial matrix fraction, GBM and TBM widths, improved, and in some cases returned to normal. Thus, the results provide the first evidence in man that established diabetic nephropathy lesions can be reversed!
Comment: Thus, while early evidence that euglycemia induced by a functioning pancreas transplant would improve diabetic complications was weak, the present study is ineluctably clear. Nodular and diffuse diabetic intercapillary glomerular sclerosis can be reversed after a decade of euglycemia - a stunning finding underscoring both the importance of hyperglycemia in the pathogenesis of diabetic microvasuclopathy and the utility of pancreas transplants. Before advocating the universal application of pancreas transplants in type 1 diabetic individuals however, it must be appreciated that 35% of recipients undergo major surgical complications. Furthermore, Gruessner and Najarian now advocate that the high rate of complications is reason to restrict pancreas transplants to recipients younger than age 45 using donors younger than age 45. (Eli Friedman, M.D., SUNY Health Science Center, Brooklyn, NY)
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ASN 30th Annual Meeting, San Antonio
Proteinuria/Hematuria : Diabetes
Transplant : Transplantation