Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
First Faculty of Medicine, Charles University, Prague, Czech Republic.
Am J Transplant. 2020 Oct;20(10):2832-2841. doi: 10.1111/ajt.15924. Epub 2020 May 13.
Early worsening of diabetic retinopathy due to sudden glucose normalization is a feared complication of pancreas transplantation; however, its rate or severity has not been studied prospectively. We followed up 43 pancreas and kidney recipients for a composite endpoint comprising new need for laser therapy, newly diagnosed proliferation, macular edema, visual acuity worsening, and blindness over 12 months. Although 37% of patients met this primary endpoint, its severity was rather low. Mean central retinal thickness and proportion of patients with subclinical macular edema increased significantly, with spontaneous resolution in half of them. Visual acuity did not change. There was no significant difference in the absolute glycated hemoglobin (HbA1c) drop, age, and diabetes duration between the patients who met and those who did not meet the primary endpoint, but a higher proportion of patients with worsening had a recent history of laser treatment. Retinopathy remained stable in 62.8% of patients. In 26%, the visual acuity significantly improved. Although retinopathy worsening was documented in more than one-third of patients, its evolution was not related to the magnitude of metabolic change; rather, it corresponded to the expected natural course of retinopathy. Nonetheless, comprehensive ophthalmologic care should be a substantial component of the recipient management.
由于血糖突然正常化导致的糖尿病性视网膜病变恶化是胰腺移植的一种可怕并发症；然而，其发生率或严重程度尚未被前瞻性研究。我们对 43 名胰腺和肾脏移植受者进行了随访，以复合终点包括在 12 个月内需要新的激光治疗、新诊断的增殖、黄斑水肿、视力恶化和失明。尽管 37%的患者符合这一主要终点，但严重程度相当低。平均视网膜中央厚度和患有亚临床黄斑水肿的患者比例显著增加，其中一半患者的病情自行缓解。视力没有改变。在符合和不符合主要终点的患者之间，绝对糖化血红蛋白（HbA1c）下降、年龄和糖尿病持续时间没有显著差异，但病情恶化的患者中有更高比例的人近期有激光治疗史。62.8%的患者视网膜病变保持稳定。26%的患者视力显著改善。尽管超过三分之一的患者出现了视网膜病变恶化，但这种变化与代谢变化的幅度无关，而是与视网膜病变的预期自然病程相对应。尽管如此，全面的眼科护理应该是受者管理的一个重要组成部分。
