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Open Access 01-08-2019 | Kidney Transplantation | Article

Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation

Authors: Shazli Azmi, Maria Jeziorska, Maryam Ferdousi, Ioannis N. Petropoulos, Georgios Ponirakis, Andrew Marshall, Uazman Alam, Omar Asghar, Andrew Atkinson, Wendy Jones, Andrew J. M. Boulton, Michael Brines, Titus Augustine, Rayaz A. Malik

Published in: Diabetologia | Issue 8/2019

Abstract

Aims/hypothesis

The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes.

Methods

This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy results in 32 healthy (non-diabetic) control participants, 29 individuals with type 1 diabetes and severe diabetic peripheral neuropathy [DPN] and 36 individuals with type 1 diabetes after SPK.

Results

Following SPK, HbA_1c, eGFR, triacylglycerols and HDL improved significantly (all p < 0.05). Compared with the DPN group, which remained unchanged over the 36 month study period, corneal confocal microscopy assessments improved over 36 months following SPK, with increasing corneal nerve fibre density of 5/mm² (95% CI 1.8, 8.2; p = 0.003) and corneal nerve fibre length of 3.2 mm/mm² (95% CI 0.9, 5.5; p = 0.006). The Neuropathy Symptom Profile and peroneal nerve conduction velocity also improved significantly by 36 months compared with DPN (2.5; 95% CI 0.7, 4.3; p = 0.008 and 4.7 m/s; 95% CI 2.2, 7.4; p = 0.0004, respectively), but with a temporal delay compared with the corneal confocal microscopy assessments. Intraepidermal nerve fibre density did not change following SPK; however, mean dendritic length improved significantly at 12 (p = 0.020) and 36 (p = 0.019) months. In contrast, there were no changes in the Neuropathy Disability Score, quantitative sensory testing or cardiac autonomic function assessments. Except for a small decrease in corneal nerve fibre density in the healthy control group, there were no changes in any other neuropathy measure in the healthy control or DPN groups over 36 months.

Conclusions/interpretation

SPK is associated with early and maintained small nerve fibre regeneration in the cornea and skin, followed by an improvement in neuropathic symptoms and peroneal nerve conduction velocity.

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Title: Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation
Authors: Shazli Azmi
Maria Jeziorska
Maryam Ferdousi
Ioannis N. Petropoulos
Georgios Ponirakis
Andrew Marshall
Uazman Alam
Omar Asghar
Andrew Atkinson
Wendy Jones
Andrew J. M. Boulton
Michael Brines
Titus Augustine
Rayaz A. Malik
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keywords: Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Diabetic Neuropathy
Diabetic Neuropathy
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Type 1 Diabetes
Published in: Diabetologia / Issue 8/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-019-4897-y

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