Endocrine Abstracts

Background: Simultaneous pancreas-kidney transplantation is an effective intervention for selected patients with insulin-dependent diabetes and end-stage chronic kidney disease (CKD), offering freedom from dialysis, insulin injections, and daily blood glucose monitoring. However, limited data exists on the impact of CKD complications on patient survival post-transplantation.

Case Presentation: A 58-year-old woman with Type 1 Diabetes (T1D) diagnosed in 1987 at the age of 22, end-stage CKD diagnosed in 2006, who underwent simultaneous pancreas-kidney transplantation in 2014, presented to our clinic for an annual check-up. It was known from her medical history that the patient had developed multiple diabetic complications such as diabetic kidney disease, diabetic retinopathy, and diabetes-related foot disease as a result of poor early glycemic control. Additionally, severe osteoporosis has developed since 2010 due to secondary hyperparathyroidism (HPT), treated with denosumab and cinacalcet. In 2022, she was diagnosed with tertiary HPT based on ultrasound signs of parathyroid glands hyperplasia, a decrease of bone mineral density (BMD), and multiple vertebral fractures on X-ray, although surgical intervention was not pursued, and alfacalcidol was added. A primary laboratory survey performed in our clinic showed HbA1c at 6.4%, C-peptide at 1.95 ng/ml, and normoglycemia without insulin. Under this treatment, creatinine clearance measured 49 mL/min, PTH and corrected total serum calcium remained within the normal range. While both transplants function appeared satisfactory, BMD remained stable since 2022 without any improvement despite treatment. Ophthalmic examination revealed no progression of retinopathy. Considering the limited impact of nonsurgical HPT treatment on skeletal health, parathyroidectomy was recommended.

Conclusions: This case highlights a nine-year remission period following successful simultaneous pancreas-kidney transplantation in a T1D patient. However, it also underscores the progressive nature of complications post-transplantation, necessitating careful monitoring and timely intervention to prevent further complications.