October 1987

Pancreatic Endocrine Insufficiency in Posttransplant Cystinosis

Author Affiliations

From the Departments of Pediatrics, The Johns Hopkins School of Medicine and The Johns Hopkins Hospital, Baltimore (Drs Fivush and Porter); the Departments of Pediatrics, North-western University Medical School and The Children's Memorial Hospital, Chicago (Dr Green); the Department of Pediatrics, Hospital for Sick Children, Toronto (Dr Balfe); the Department of Pediatrics, Hôpital Sainte-Justine, Montreal (Dr O'Regan); and the Section on Human Biochemical Genetics, Human Genetics Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md (Dr Gahl).

Am J Dis Child. 1987;141(10):1087-1089. doi:10.1001/archpedi.1987.04460100065027

• Nephropathlc cystinosis causes renal death by approximately age 10 years. With increased life span due to kidney transplantation, ten to 25 years of cystine accumulation has resulted in pancreatic complications in individuals with cystinosis. We noted severe hyperglycemia in five posttransplant patients, three of whom remained insulin-dependent diabetics several years after transPlant. The clinical findings were not consistent with steroid-dependent or insulin-resistant diabetes. Pancreatic cystine deposition was detected histologically and biochemically on postmortem examination of two other patients. We conclude that hyperglycemia may be anticipated in the immediate posttransplant period in cystinotic patients and that some patients will require insulin therapy years later. The use of cystine-depleting agents should be considered in posttransplant cystinosis as an attempt to prevent potential damage to the pancreas and other organs from cystine deposition.

(AJDC 1987;141:1087-1089)