Metabolic control and progression of complications in insulin-dependent diabetic patients after kidney transplantation

• Published in: Journal of internal medicine Vol. 232; no. 3; p. 253
• Main Authors: Ekstrand, A, Groop, L, Pettersson, E, Grönhagen-Riska, C, Laatikainen, L, Matikainen, E, Seppäläinen, A M, Laasonen, E, Summanen, P, Ollus, A
• Format: Journal Article
• Language: English
• Published: England 01.09.1992
• Subjects: Adult; Analysis of Variance; Body Weight; Chi-Square Distribution; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - physiopathology; Diabetic Angiopathies - physiopathology; Diabetic Neuropathies - physiopathology; Diabetic Retinopathy - physiopathology; Female; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Nutritional Status; Prospective Studies; Survival Analysis
• ISSN: 0954-6820
• DOI: 10.1111/j.1365-2796.1992.tb00580.x

Patient survival and progression of complications were monitored for 3 years after kidney transplantation in 29 type-1 diabetic patients. Ten age-matched, non-diabetic kidney-transplanted patients served as controls. Five diabetic patients died during follow-up (three cardiovascular events, two infections), three diabetic patients had a non-fatal myocardial infarction and four developed cerebrovascular complications after transplantation. Of the diabetic patients, 69% suffered from proliferative retinopathy before transplantation; 20% of them improved, 65% remained unchanged and 15% deteriorated after transplantation. Motor but not sensory conduction velocity measured from the nervus medianus improved after transplantation. Autonomic neuropathy was observed in 50% of the patients and was unaffected by transplantation. Glycaemic control did not improve significantly during follow-up (HbA1, 10.6 +/- 0.5% before and 9.5 +/- 0.6% 3 years after transplantation). Body weight increased in both diabetic and non-diabetic patients within 3 years after transplantation (from 68 +/- 2 to 77 +/- 6 kg in diabetics, P less than 0.01; from 167 +/- 4 to 77 +/- 6 kg in non-diabetics, P less than 0.01). Subcutaneous fat thickness measured from computer tomography scans of the calf increased in diabetic patients from 5.0 +/- 0.6 to 6.1 +/- 0.9 mm (P less than 0.05). However, the cross-sectional areas of triceps and calf muscles did not increase, suggesting that the increase in body weight was solely due to an increase in fat. It is clear that diabetes-related complications continue to progress and are not influenced by a successful kidney transplant.