Diabetic muscle infarction after simultaneous pancreas-kidney transplant

Diabetic muscle infarction (DMI) is a rare entity that occurs in patients with long‐standing type 1 insulin dependent diabetes mellitus (IDDM). We describe DMI occurring on an average of 5 months after SPK in four patients with IDDM and end stage renal disease (ESRD). These patients had evidence of other long‐term diabetic complications including retinopathy and neuropathy, as well as microangiopathy and hypercoagulability, both of which are pre‐disposing factors for DMI. The etiology of DMI is not well understood. Despite establishment of normoglycemia after kidney–pancreas transplantation, DMI may occur as a result of tissue damage/fragility secondary to the pre‐existing long‐term labile glycemic control and hypertension. This may be exacerbated by the pro‐coagulant effects of the calcineurin‐inhibitors and the use of steroids as part of the immunosuppressive regimen.