Related Experiment Videos
Diabetic muscle infarction after simultaneous pancreas-kidney transplant
Spiros Delis1, Gaetano Ciancio, Javier Casillas
1Department of Surgery, Division of Transplantation, University of Miami School of Medicine, Miami, FL 33101, USA.
Abstract:
Diabetic muscle infarction (DMI) is a rare entity that occurs in patients with long-standing type 1 insulin dependent diabetes mellitus (IDDM). We describe DMI occurring on an average of 5 months after SPK in four patients with IDDM and end stage renal disease (ESRD). These patients had evidence of other long-term diabetic complications including retinopathy and neuropathy, as well as microangiopathy and hypercoagulability, both of which are pre-disposing factors for DMI. The etiology of DMI is not well understood. Despite establishment of normoglycemia after kidney-pancreas transplantation, DMI may occur as a result of tissue damage/fragility secondary to the pre-existing long-term labile glycemic control and hypertension. This may be exacerbated by the pro-coagulant effects of the calcineurin-inhibitors and the use of steroids as part of the immunosuppressive regimen.
Insights
Diabetic muscle infarction (DMI) is a rare complication in patients with type 1 diabetes. This study highlights DMI occurring post-kidney-pancreas transplant in patients with end-stage renal disease and diabetes, suggesting underlying diabetic complications contribute.
Area of Science:
- Endocrinology
- Nephrology
- Vascular Medicine
Background:
- Diabetic muscle infarction (DMI) is a rare complication typically seen in patients with long-standing type 1 insulin-dependent diabetes mellitus (IDDM).
- End-stage renal disease (ESRD) often coexists with long-term diabetic complications.
Observation:
- This case series describes four patients with IDDM and ESRD who developed DMI approximately 5 months after simultaneous kidney-pancreas transplantation (SPK).
- These patients exhibited pre-existing diabetic complications like retinopathy, neuropathy, microangiopathy, and hypercoagulability, known risk factors for DMI.
Findings:
- Despite achieving normoglycemia post-transplantation, DMI occurred, indicating that pre-existing tissue damage from labile glycemic control and hypertension plays a role.
- The use of calcineurin inhibitors and steroids in immunosuppressive regimens may exacerbate DMI risk due to their pro-coagulant effects.
Implications:
- DMI can occur even after successful SPK in patients with a history of long-term diabetes and its complications.
- Understanding these contributing factors is crucial for managing and potentially preventing DMI in this vulnerable patient population.