Iwatsuki, Shunzaburo

Starzl, Thomas E

English

PubMed

D-Scholarship@Pitt

Diabetic Nephropathy 2:26, 1983. Case Report: The Unusual Diabetic Recipient of a Cadaveric Kidney after a Decade Thomas E. Starzl, MD, PhD, and Shunzaburo Iwatsuki, MD Department of Surgery, University of Pittsburgh Health Center~Drniversity of Pittsburgh,"{ Pittsburgh, Pennsylvania .. INTRODUCTION At a recent international nephrology meeting in Bologna. one of the editors of this journal (E.A.F.) asked the other participants for documentation of successful cadaveric renal transplantation in type I diahetic patients treated 10 years or longer. ago. There \\.ere few responses. since, before this time. general appreciation that such patients could be treated effectively with cadaveric transplantation had not yet been awakened by the important stud-ies of 1"ajarian and his associates at the University of Minnesota. The request was made by E.A.F. that brief reports of these un-usual lO·year survlvors be submined. CASERE?ORT A 29-year-old wife of a physician had had type I diabetes melli-:us since age 10. She developed renal failure in February 1971. :Jnd • ... ·as ac:>ted with hem~ialvsis for 11 months before trans-;-'"m3rion. Her in~uljn require~ents we;-e 15 units Lente,·day. ol<;ually suP?Ic:memed with 0-15 unitsiday regular.insulin accord-ing to need. She deye\oped visual difficulties from retinal hemor-rhages and retinopathy at age 28. and during the II-month period of pre-transplantation dialysis. she became permanently blind in the ril!ht eve from intraocular hemorrha2e durim! dialvsis. Her gener~l cE1~dition rapidly deteriorated. requiring ~most continu-ous hospitalization. Peripheral neuropathy waS very severe. with hilateral footdrop and bilateral anesthesia below the knees. Cadaveric renallransplantation was carried out on March 9. 1972. under therapy with cyclophosphamide, prednisone and anti-lymphocyte globulin (ALG). Several months later the cy-clophosphamide was changed to azathioprine. The donor was a 19-year-old Caucasian female. Tissue matching was random. and there were n(1 ami2en matches at the HLA-A and B loci. Conva-le~cence wa~ ext~mely difficult because of pre -existing disabil-ity, and because of problems with glucose control. Mild rejection was diagnosed at 5 weeks and easily reversed. The neuropathy , .. :~ .-'- .- ... :.r-.-· slowly improvep., and after 2 y~Ds 'she couIdstOp,wearlng piano wire foot and leg braces. Daily prednisone was'weaDed to 20 mg by 1 year, and her present dose is 15;:Ptg/day. Azathioprine dose is 75 mg/day. Current daily insuliIi tequirem~nts are_20 units Lente. supplemented with 16-26 units ofregulirinsulin. Almost 11 years after transplantation her BUN is 11 mg%, ~erum creatinine 0.7 mg%, and creatinine clearance 75 ml/min. Urinalysis shows no protein or other abnonnalities. Postoperatively, her environment was structured to allow her to function within the home and elsewhere despite partial blind-ness. Cataract extraction from the left eye was perfonned 6 mon-ths after transplantation. Because offailing vision of the "good" left eye. total vitrectomy was perfonned in May 1979. Enough vision was restored to permit perfonnance of simple tasks. A second "itrectomy was perfonned in· September, 1980. Subse-quently. ~he has had glaucoma (treated with laser). She is now legally blind. bULstill has light perception. The ;:::atitnt is a vital and highly motivated person who partici-~ates in a number of communitv functions. including the affairs ~f the American Diabetes Ass~iation and the National Kidney Foundation. SUMMARY A partially blind diabetic woman who received a cadaveric kid-nev more than ten years a2:O obtained worth-while rehabilitation as the result of continuous-excellent function of her graft. ACKNOWLEDGEMENTS Supported by a re!'.earch grant from the Veterans Administration: by a project grant AM-2996l from the National Institutes of Health and by grant RR-00084 from the General Clinical Research Centers Program of the Division of Research Resources. Nationallnstinnes of Health. The transplantation and other care were provided at the University of Colorado Health Sciences Center. Denver. Colorado. 

The Unusual Diabetic Recipient of a Cadaveric Kidney after a Decade.

http://d-scholarship.pitt.edu/3900/1/31735062114784.pdf

The Unusual Diabetic Recipient of a Cadaveric Kidney after a Decade.

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