Signs of nerve regeneration following pancreas transplantation in an insulin-dependent diabetic with neuropathy

Nerve disease is a common complication of diabetes mellitus. Hyperglycemia directly or indirectly causes structural damage and functional impairment of nerve fibers. Despite conventional therapy, there continues to be a substantial incidence of diabetic complications. Development of complications is thought to be due to abnormal fluctuations in blood glucose levels. The number of pancreas transplants performed for the treatment of diabetic complications has increased dramatically in the last few years. Unlike conventional therapy, functional pancreas grafts provide normal fasting blood glucose levels, near-normal glucose tolerance, and normal levels of glycosylated hemoglobin. In this report, we address the following question: will functional pancreas grafts prevent or reverse the structural nerve damage caused by diabetes mellitus?A 53 y/o man developed insulin-dependent diabetes at age 35. Nephropathy, retinopathy, and neuropathy developed despite conventional insulin therapy. To treat these complications, pancreas segment transplant was performed. The donor was his identical twin. The recipient was treated with low-dose immunosuppressive drugs (azathioprine and prednisone). He has remained euglycemic for 3 years and requires neither insulin therapy nor oral hypoglycemic agents. Clinical examinations during the 3 years post-transplantation have revealed progressive improvement in vision, nerve function and a stabilization in renal function.