P-163

Resolution of long standing Necrobiosis Lipoidica Diabeticorum (NLD) lesion after restoration of euglycaemia following successful pancreas after kidney (PAK) transplant

M.J. Mazur¹, A.C. Lowney¹, J. Prigoff², R.L. Heilman³, H. Chakkera³, A. Moss², D. Mulligan², K. Reddy², K. Hamawi^3
1 Cork University Hospital, Department of Nephrology, Cork, Ireland; ² Mayo Clinic Arizona, Transplant Center, Phoenix, USA; ³ Mayo Clinic Arizona, Department of Medicine, Phoenix, USA

Case Report: Our patient is a 59 year old female with DM type 1 since she was 9. She was diagnosed with NLD one year later. Her right shin was affected. The lesion was well-demarcated, shiny and yellow to light brown in color, without any ulcerations. No specific treatment had ever been offered and the lesion remained unchanged for decades. She went on to develop CKD stage V and became hemodialysis dependant when she was 55 years old. One year later she received a LRRT. She was induced with IVIG and r-ATG. Her immunosuppression was with tacrolimus, mycophenolate mofetil and prednisone. Creatinine stabilized at 1.2 mg/dl (eGFR 46 ml/min/1.73 m²). She received PAK 3 years later. Induction therapy was with alemtuzumab and IVIG. She remained on tacrolimus, mycophenolate mofetil and prednisone. The pancreas allograft had excellent function and she became euglycemic. At 4 weeks after PAK she reported complete resolution of her NLD. There has been no recurrence of NLD for 3 years of follow up at which point the lesion reappeared, despite persistence of euglycemia. Discussion: This is the first report of resolution of longstanding (nearly 5 decades) NLD following PAK. The fact that the patient was on the same antirejection agents for 3 years prior to pancreas transplantation makes it unlikely that the state of immunosuppression or any particular pharmacological agent was responsible for NLD resolution.

Conclusion: Resolution of NLD should be included among other potential benefits of pancreas transplantation.

P-163

Resolution of long standing Necrobiosis Lipoidica Diabeticorum (NLD) lesion after restoration of euglycaemia following successful pancreas after kidney (PAK) transplant

M.J. Mazur¹, A.C. Lowney¹, J. Prigoff², R.L. Heilman³, H. Chakkera³, A. Moss², D. Mulligan², K. Reddy², K. Hamawi^3
1 Cork University Hospital, Department of Nephrology, Cork, Ireland; ² Mayo Clinic Arizona, Transplant Center, Phoenix, USA; ³ Mayo Clinic Arizona, Department of Medicine, Phoenix, USA

Case Report: Our patient is a 59 year old female with DM type 1 since she was 9. She was diagnosed with NLD one year later. Her right shin was affected. The lesion was well-demarcated, shiny and yellow to light brown in color, without any ulcerations. No specific treatment had ever been offered and the lesion remained unchanged for decades. She went on to develop CKD stage V and became hemodialysis dependant when she was 55 years old. One year later she received a LRRT. She was induced with IVIG and r-ATG. Her immunosuppression was with tacrolimus, mycophenolate mofetil and prednisone. Creatinine stabilized at 1.2 mg/dl (eGFR 46 ml/min/1.73 m²). She received PAK 3 years later. Induction therapy was with alemtuzumab and IVIG. She remained on tacrolimus, mycophenolate mofetil and prednisone. The pancreas allograft had excellent function and she became euglycemic. At 4 weeks after PAK she reported complete resolution of her NLD. There has been no recurrence of NLD for 3 years of follow up at which point the lesion reappeared, despite persistence of euglycemia. Discussion: This is the first report of resolution of longstanding (nearly 5 decades) NLD following PAK. The fact that the patient was on the same antirejection agents for 3 years prior to pancreas transplantation makes it unlikely that the state of immunosuppression or any particular pharmacological agent was responsible for NLD resolution.

Conclusion: Resolution of NLD should be included among other potential benefits of pancreas transplantation.