P-218

Five transplantations over ten years - a case study of patient with instable diabetes and severe diabetes complications

E. ?íhalová¹, A. Romanová², T. Jedináková², F. Saudek^2
1 Institute Clinical and Experimental Medicine, Langerhans Islet Laboratory, Prague, Czech Republic; ² Institute Clinical and Experimental Medicine, Diabetology Clinic, Prague, Czech Republic

Objective: Pancreas or islet transplants are usually performed simultaneously with or following a kidney transplantation in type-1 diabetic recipients suffering from end-stage nephropathy. Isolated pancreas or islet transplants still remain reserved for subjects with highly instable metabolic control, who need to be aware of the potential risks. We refer on a patient who gradually underwent all these medical treatments.

Methods and Results: A 23 years old female with diabetes since age of 9, visited the Department of Diabetes in 1996 concerned about rapid progression retinopathy, neuropathy, proteinuria of 0.5 g/day and creatinine clearance of 1.1 ml/sec. Diabetes control improved upon insulin pump treatment but hypoglycaemia unawareness and retinopathy continuously deteriorated. Therefore, in 2000 pancreas transplantation was performed. Though she was insulin-free and normoglycemic, renal function deteriorated and after a period of haemodialysis, a deceased donor kidney transplantation was performed in 2002. In 2004 a rejection episode of the kidney was successfully treated, but the pancreas graft failed and the patient strived for pancreas re-transplantation. This procedure was however evaluated as too risky. She was included in the islet transplant program and underwent 3 implantations. Glycaemia stabilized at almost normal levels with approx. 10 IU of insulin per day with no serious episodes of hypoglycaemia. Since 2009 however the kidney graft function started to deteriorate due to rejection nephropathy and in 2010 peritoneal dialysis was initiated. The patient has not lost her enthusiasm for life and supported by her family, she is being evaluated prior to placement on a list for kidney re-transplantation. Still on imunosuppression.

Conclusion: This case documents all current possibilities of an integrated dialysistransplantation programme for diabetic subjects, which even in a complicated course brings benefit and improves the quality of life to those with the necessary positive approach and strong motivation.

P-218

Five transplantations over ten years - a case study of patient with instable diabetes and severe diabetes complications

E. ?íhalová¹, A. Romanová², T. Jedináková², F. Saudek^2
1 Institute Clinical and Experimental Medicine, Langerhans Islet Laboratory, Prague, Czech Republic; ² Institute Clinical and Experimental Medicine, Diabetology Clinic, Prague, Czech Republic

Objective: Pancreas or islet transplants are usually performed simultaneously with or following a kidney transplantation in type-1 diabetic recipients suffering from end-stage nephropathy. Isolated pancreas or islet transplants still remain reserved for subjects with highly instable metabolic control, who need to be aware of the potential risks. We refer on a patient who gradually underwent all these medical treatments.

Methods and Results: A 23 years old female with diabetes since age of 9, visited the Department of Diabetes in 1996 concerned about rapid progression retinopathy, neuropathy, proteinuria of 0.5 g/day and creatinine clearance of 1.1 ml/sec. Diabetes control improved upon insulin pump treatment but hypoglycaemia unawareness and retinopathy continuously deteriorated. Therefore, in 2000 pancreas transplantation was performed. Though she was insulin-free and normoglycemic, renal function deteriorated and after a period of haemodialysis, a deceased donor kidney transplantation was performed in 2002. In 2004 a rejection episode of the kidney was successfully treated, but the pancreas graft failed and the patient strived for pancreas re-transplantation. This procedure was however evaluated as too risky. She was included in the islet transplant program and underwent 3 implantations. Glycaemia stabilized at almost normal levels with approx. 10 IU of insulin per day with no serious episodes of hypoglycaemia. Since 2009 however the kidney graft function started to deteriorate due to rejection nephropathy and in 2010 peritoneal dialysis was initiated. The patient has not lost her enthusiasm for life and supported by her family, she is being evaluated prior to placement on a list for kidney re-transplantation. Still on imunosuppression.

Conclusion: This case documents all current possibilities of an integrated dialysistransplantation programme for diabetic subjects, which even in a complicated course brings benefit and improves the quality of life to those with the necessary positive approach and strong motivation.