Successful pancreas and kidney transplantation: a view of metabolic control.
BACKGROUND
Pancreas and kidney transplantation (PKTx) has become the treatment of choice in uremic patients with insulin-dependent diabetes mellitus (IDDM). In these patients, the pancreatic graft provides an endogenous source of insulin. However, the determination of its long-term effect on metabolic control is crucial in order to establish the real efficacy of this treatment in diabetic patients. In this article, we describe the experience of the University of Barcelona in short- and long-term metabolic control in PKTx recipients.


METHODS
We performed seriated determinations of glycosilated hemoglobin (HbA1c) and oral glucose tolerance tests (OGTT) in 55 patients who underwent PKTx at our center from 1983 to 1996 with both grafts functioning for more than 1 yr (mean follow-up 4.2 +/- 2.3 yr). Basal glucose and insulin levels, areas under the curve (AUC) of glycemia and insulinemia after OGTT were analyzed throughout follow-up, as well as fasting insulin resistance index (FIRI).


RESULTS
HbA1c levels throughout follow-up were within the normal range. The OGTT was normal in 80% of the patients 5 yr after transplantation. Hyperinsulinemia was present throughout follow-up. Over time, no differences were detected in the AUC of glycemia and insulinemia between controls and patients with PKTx. During the evolution, no differences were found in FIRI, in spite of increasing body weight.


CONCLUSIONS
When successful, PKTx provides long-term normalization of glycemic control, assessed by HbA1c and OGTT, despite the existence of sustained hyperinsulinemia. Our results strongly suggest that PKTx is the most effective treatment for uremic patients with IDDM from a metabolic point of view.
Fernández Balsells
M
M
Endocrinology Unit, Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain.
Esmatjes
E
E
Ricart
M J
MJ
Casamitjana
R
R
Astudillo
E
E
Ferńandez Cruz
L
L
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin