Effect of successful combined renal and pancreatic transplantation on diabetic retinopathy

The treatment of diabetic retinopathy (DR) is one of the most challenging problems in ophthalmology. The possibility of modulating DR by successful combined kidney and pancreas transplantation thus holds an attractive promise for the ophthalmologist. From June 1983 until April 1997, a total of 86 combined kidney and pancreas transplantation procedures were performed at the Prague-based Institute for Clinical and Experimental Medicine. All recipients are on close follow-up in terms of their ophthalmic status. However, evaluation of the effect of transplantation is problematic because of the advanced status of DR prior to the procedure. We divided the transplant recipients into two groups according to type of transplantation. In Group I (segmental transplantation), proliferative DR was present in 100% eyes, 70% had undergone vitrectomy, and there were 21% of blind eyes. All eyes had been treated by laser. In this group, long-term stabilization of the finding was observed in three patients. In Group II (whole pancreas transplantation), proliferative and non-proliferative DR was diagnosed in 86% and 14%, respectively. There were 12% of blind eyes, and 70% had been treated by laser prior to transplantation. After a successful transplantation, stabilization was found in 60%, improvement in 18%, and deterioration in 22% of eyes in this group. The stabilization and improvement can be explained by subsequent normoglycemia (HbAlc 5.6%). By contrast, we were unable to provide a satisfactory explanation for the deterioration and progression of these findings. While the effect of immunosuppression on DR remains unclear, it obviously accelerates the existing cataract.

Successful combined transplantation has a beneficial effect on DR and is worthwhile even for patients at the end stage on account of its beneficial psychosocial effect and prevention of dolorous glaucoma. However, many effects of the procedure on the eye of diabetics remain to be identified in future studies.