Persistent Need for Ophthalmic Follow-Up After Simultaneous Pancreas–Kidney Transplantation: Long-Term Effects on Diabetic Retinopathy and Quality of Life

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Abstract
Background: Simultaneous pancreas–kidney transplantation (SPKT) is an effective treatment for patients with type 1 diabetes (T1D) and end-stage kidney disease (ESKD). However, its long-term impact on diabetic retinopathy (DR) stability is not fully understood. This study evaluated DR severity, visual outcomes, and health-related quality of life (HRQoL) in patients with T1D post-SPKT. Methods: This quantitative longitudional study included 24 patients with T1D and ESKD who underwent SPKT between 2013 and 2020. Data included HbA1cand creatinine levels, comprehensive ophthalmic evaluations with fundus imaging, and HRQoL assessment using the 15D instrument. Results: Eighteen patients completed follow-up. The mean age at SPKT was 39 ± 7 years, with 67% male. Post-SPKT, HbA1c and creatinine improved significantly among all participants. The mean ETDRS letter gain was 5.2 letters (95% CI 0.03 to 10.29; p = 0.049). Cataract progression occurred in 39% of phakic eyes (p < 0.001), and seven patients had previous cataract surgery. Seventeen (89%) patients had proliferative DR (PDR) pre-SPKT, with 28% progressing to sight-threatening DR post-SPKT (p = 0.037). One patient (6%) was visually impaired. HRQoL scores were comparable to controls, though patients with PDR had lower vision-related scores (p = 0.023). Conclusions: Despite metabolic improvements after SPKT, 28% of patients experienced DR progression to severe PDR, highlighting the need for long-term ophthalmic follow-up.

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