End-stage renal failure in juvenile diabetes mellitus: a 5-year follow-up of treatment.

A group of 43 juvenile diabetic patients accepted for renal transplantation and followed up for as long as 5 years was studied. The cumulative survivial of the group was 66% at 1 year and 58% at 5 years. The 1-year survival of those receiving cadaveric renal allografts (65%) or of those on dialysis alone (55%) was less than the survival of those after living related donor transplantation (88%). The major morbid sequelae included retinopathy, neuropathy, and peripheral vascular disease. While patients were on dialysis, blindness increased, with 44% of the bilateral blindness and 27% of the unilateral blindness representing new cases. After transplantation, permanent unilateral or bilateral blindness developed in an additional 12% of the patients. Severe neuropathy progressed rapidly in patients on dialysis and improved after transplantation in all. Fifty percent of the patients who survived transplantation 1 year or more required amputation of one or more extremities. Only 25% of the patients who survived 1 year after transplantation were without blindness, severe peripheral vascular problems, or both.