Abstract

Objective: To evaluate whether islet transplantation may stabilize polyneuropathy in uremic type 1 diabetic patients (ESRD+T1DM) who received a successful islets after kidney transplantation (KI-s).

Research Design and Methods: 18 KI-s patients underwent electroneurographic tests of sural, peroneal, ulnar, and median nerves: the patient nerve conduction velocity (NCV) index and amplitudes of both sensory action potentials (SAPs) and compound motor action potentials (CMAPs) were analyzed longitudinally at 2, 4, and 6 years after islet transplantation. Skin content of advanced glycation end products (AGEs) and expression of their specific receptors (RAGE) were also studied at the 4-year follow-up. Nine ESRD+T1DM patients who received kidney transplantation alone (KD) served as controls.

Results: The NCV score improved in the KI-s group up to the 4-year time point (p=0.01 versus baseline), and stabilized 2 years later, whereas the same parameter did not significantly change in the KD group throughout the follow-up period or when a cross-sectional analysis between groups was performed. Either SAP or CMAP amplitudes recovered in the KI-s group, while they continued worsening in KD controls. AGE and RAGE–levels in perineurium and vasa nervorum of skin biopsies were lower in the KI-s than in the KD group (P<0.01 for RAGE).

Conclusions: Islet transplantation seems to prevent long-term worsening of polyneuropathy in ESRD+T1DM patients who receive islets after kidney transplantation. No statistical differences between the two groups were evident at cross-sectional analysis. Reduction in AGE/RAGE expression in the peripheral nervous system was shown in patients receiving islet transplantation.