title: Differing effects of pancreas-kidney transplantation with systemic versus portal venous drainage on cholesteryl ester transfer in IDDM subjects.
abstract: OBJECTIVE
  Cholesteryl ester transfer (CET) is accelerated in patients with IDDM treated with conventional (subcutaneous) insulin therapy (CIT) and a number of other disorders associated with premature cardiovascular disease. We have shown that in IDDM this disturbance is closely linked to iatrogenic hyperinsulinemia (HI), because it was reversed when insulin was administered by the intraportal (i.p.) route. In this study, we sought to determine whether HI after successful pancreas-kidney transplantation (PKT) has the same adverse effect on CET.
  
  
  METHODS
  CET was measured by both mass and isotopic assays and compared in two groups of euglycemic non-insulin-requiring IDDM PKT patients with either systemically draining allografts and persistent HI or grafts with portal vein anastomoses that were normoinsulinemic (PK-P). A third group of eight nondiabetic kidney transplant (KT) patients receiving the same immunosuppressive drugs served as control subjects.
  
  
  RESULTS
  CET in pancreas-kidney transplantation subjects with systemic venous drainage (PK-S) was increased (P < 0.001) to the same level we have reported previously in IDDM patients receiving CIT and was significantly higher (P < 0.001) than in those subjects with PK-P. CET in the PK-P group did not differ from that of the KT control patients.
  
  
  CONCLUSIONS
  CET is affected by variations in systemic insulin levels in pancreas transplant patients with allografts that have differing venous drainage. Because high systemic insulin levels are linked to the activation of (ET, euglycemic HI IDDM pancreas allograft recipients may continue to be at high risk for macrovascular complications.
authors.affiliation: Department of Medicine, Rush Medical College, Chicago, Illinois, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Bagdade
authors.forename: M C
authors.initials: MC
authors.lastname: Ritter
authors.forename: A E
authors.initials: AE
authors.lastname: Kitabchi
authors.forename: E
authors.initials: E
authors.lastname: Huss
authors.forename: R
authors.initials: R
authors.lastname: Thistlethwaite
authors.forename: O
authors.initials: O
authors.lastname: Gabfr
authors.forename: H
authors.initials: H
authors.lastname: Lambeth
mesh_terms: D000328:Adult; D002352:Carrier Proteins / Q000097:blood*; D002784:Cholesterol / Q000097:blood; D053480:Cholesterol Ester Transfer Proteins; D008076:Cholesterol, HDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000097:blood / Q000601:surgery*; D005260:Female; D006023:Glycoproteins; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007676:Kidney Failure, Chronic / Q000097:blood / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods* / Q000502:physiology; D011169:Portal Vein / Q000601:surgery; D014280:Triglycerides / Q000097:blood
chemical_list: C506642:CETP protein, human; D002352:Carrier Proteins; D053480:Cholesterol Ester Transfer Proteins; D008076:Cholesterol, HDL; D006023:Glycoproteins; D014280:Triglycerides; D002784:Cholesterol