Epidermal Innervation in Type 1 Diabetic Patients

A 2.5-year prospective study after simultaneous pancreas/kidney transplantation

  1. Petr Boucek, MD1,
  2. Terezia Havrdova, MD1,
  3. Ludek Voska, MD2,
  4. Alena Lodererova, MS2,
  5. Lan He3,
  6. Frantisek Saudek, MD1,
  7. Kvetoslav Lipar, MD1,
  8. Milos Adamec, MD1 and
  9. Claudia Sommer, MD3
  1. 1Diabetes and Transplant Centers, Prague, Czech Republic
  2. 2Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
  3. 3Department of Neurology, University of Würzburg, Würzburg, Germany
  1. Corresponding author: Petr Boucek, petr.boucek{at}ikem.cz


OBJECTIVE—To assess the effect of normoglycemia following simultaneous pancreas/kidney transplantation (SPK) on neurological function and intraepidermal nerve fiber density (IENFD) in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—We performed vibration perception threshold (VPT) testing and autonomic function testing (AFT) and assessed IENFD in skin biopsies from the lower thigh and upper calf in 14 healthy control subjects and 18 patients with type 1 diabetes at the time of and at 21–40 (median 29) months post SPK.

RESULTS—At baseline, significantly increased VPTs, pathological AFT results, and severe reduction in IENFD were present in SPK recipients. After SPK, an increase of IENFD in the thigh of more than one epidermal nerve fiber per millimeter was noted in three patients (median 4.1, range 1.9–10.2), but changes were not significant for the group as a whole.

CONCLUSIONS—We conclude that either irreversible nerve damage might be present in some SPK recipients or that longer periods of normoglycemia might be needed to allow nerve regeneration.


  • Published ahead of print at http://care.diabetesjournals.org on 28 April 2008.

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    • Received December 20, 2007.
    • Accepted April 21, 2008.
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  1. Diabetes Care vol. 31 no. 8 1611-1612
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