Hemoperfusion and functional state of the macula after simultaneous pancreas and kidney transplantation

Vorobyeva IV1,2, Bulava EV1, Moshetova LK1, Pinchuk AV3,4,5
About authors

1 Russian Medical Academy of Continuous Professional Education, Moscow, Russia

2 Peoples’ Friendship University of Russia, Moscow, Russia

3 Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russia

4 Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia

5 Research Institute of Healthcare Organization and Medical Management, Moscow, Russia

Correspondence should be addressed: Irina V. Vorobyeva
Botkinsky pr-d, 2, korp. 19, Moscow, 125284 Russia; ur.liam@0002tnecod.aniri

About paper

Acknowledgements: the authors acknowledge Prof. G.Sh. Arzhimatova of the Botkin Hospital (Moscow) for helpful discussions.

Author contribution: Vorobyeva IV — literature analysis, planning and coordination of the study, data analysis and interpretation; Bulava EV — literature analysis, data collection, analysis and interpretation, preparation of the manuscript; Moshetova LK — study planning and supervision, data analysis and interpretation; Pinchuk AV — study planning and supervision.

Compliance with ethical standards: the study was approved by Ethical Committee at the Russian Medical Academy of Continuous Professional Education (Protocol № 1 of January 18, 2021); the written informed consent for the study was provided by all participants.

Received: 2022-02-22 Accepted: 2022-03-10 Published online: 2022-04-05

Simultaneous pancreas and kidney transplantation (SPK) provides effective treatment in patients with type 1 diabetes mellitus (T1DM) and end-stage renal failure (ESRF), mitigating the hyperglycemia and uremic syndrome. The study aimed at the assessment of morphofunctional status of the macula and macular hemodynamics in patients with T1DM after SPK. The study enrolled 45 patients subdivided into three groups: Group A — patients with T1DM after SPK; Group B — patients with T1DM and ESRF, maintained on programmed hemodialysis (PH), on waiting list for SPK; and Group C — individuals without ophthalmic or systemic pathologies. All patients were subject to the standard ophthalmological examination complemented by measurements of the central retinal thickness (CRT) and the average perfusion density (PD) in four vascular layers: superficial capillary plexus of the retina (SCP), deep capillary plexus of the retina (DCP), choriocapillaris, and choroid. The patients after SPK had significantly lower CRT (241 ± 33 µm in Group A, 309±10 µm in Group B; p < 0.05) and significantly higher PD of the macular region in both the retina (Group A: SCP — 19.0 ± 1.6%, DCP — 10.7 ± 1.3%; Group B: SCP — 11.7 ± 0.8%, DCP — 4.8 ± 0.8%; p < 0.05) and the choroid (Group A: choriocapillaris — 28.1 ± 1.8%, choroid — 31.3 ± 1.6%; Group B: choriocapillaris — 20.4 ± 1.6%, choroid — 21.8 ± 1.3%; p < 0.05), as well as significantly higher visual acuity (Group A: 0.7 ± 0.1; Group B: 0.5 ± 0.1; p < 0.05) and macular light threshold (Group A: 25.9 ± 1.4 dB; Group B: 22.3 ± 1.1 dB; p < 0.05) compared with the patients on PH. Thus, the normalization of carbohydrate metabolism and the mitigation of uremic syndrome in patients with T1DM and ESRF after SPK favorably affect the functional condition of the macular area, as indicated by the improvement in macular blood flow and visual functions.

Keywords: diabetes mellitus, diabetic retinopathy, diabetic nephropathy, simultaneous pancreas and kidney transplantation, optical coherence tomography angiography