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Severe Epidermal Nerve Fiber Loss in Diabetic Neuropathy Is Not Reversed by Long‐Term Normoglycemia After Simultaneous Pancreas and Kidney Transplantation
Author(s) -
Havrdova T.,
Boucek P.,
Saudek F.,
Voska L.,
Lodererova A.,
Üçeyler N.,
Vondrova H.,
Skibova J.,
Lipar K.,
Sommer C.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13715
Subject(s) - medicine , glycemic , pancreas transplantation , diabetes mellitus , peripheral neuropathy , nerve fiber , diabetic neuropathy , renal function , nerve conduction velocity , transplantation , kidney transplantation , surgery , endocrinology , anatomy
Whether nerve fiber loss, a prominent feature of advanced diabetic neuropathy, can be reversed by reestablishment of normal glucose control remains questionable. We present 8‐year follow‐up data on epidermal nerve fiber (ENF) density and neurological function in patients with type 1 diabetes after simultaneous pancreas and kidney transplantation (SPK) with long‐term normoglycemia. Distal thigh skin biopsies with ENF counts, vibration perception thresholds (VPTs), autonomic function testing (AFT) and electrophysiological examinations were performed at time of SPK and 2.5 and 8 years after SPK in 12 patients with type 1 diabetes. In comparison to controls, baseline ENF density, VPT and AFT results of patients indicated severe neuropathy. At follow‐up, all SPK recipients were insulin independent with excellent glycemic control and kidney graft function; however, the severe ENF depletion present at baseline had not improved, with total ENF absence in 11 patients at 8‐year follow‐up. Similarly, no amelioration occurred in the VPT and AFT results. Numerical improvement was seen in some electrophysiological parameters; however, statistical significance was achieved only in median motor nerve conduction velocity. ENF loss and functional deficits in advanced diabetic peripheral neuropathy are rarely reversible, even by long‐term normoglycemia, which underscores the importance of neuropathy prevention by early optimal glycemic control.