Metabolic consequences of orthotopic pancreaticoduodenal transplantation with preservation of near normal physiology.
BACKGROUND
Several case reports suggested the use of pancreaticoduodenal allotransplantation alone or in combination with multivisceral transplants to treat exocrine and endocrine deficiency after pancreatectomy for chronic pancreatitis, upper abdominal malignancies, and cystic fibrosis. Our objective was to establish the metabolic consequences of this technique.


METHODS
Inbred rats, which either underwent pancreaticoduodenectomy before receiving an orthotopic duodenopancreas transplant (Tx, n= 18) or laparotomy (sham, n=18), were subjected 3 months postoperatively to oral and "isoglycemic" i.v. glucose tolerance tests with arterial blood sampling (n=12) or oral glucose tolerance test with additional portal blood sampling (n=6). Fecal fat and chymotrypsin were evaluated in the 11th postoperative week as indicators of pancreatic exocrine function in eight animals of each group.


RESULTS
The incremental arterial plasma glucose integrated over a 90-min period was similar after oral and i.v. glucose in the respective groups, but was significantly lower in Tx versus sham rats after oral glucose. Incremental portal glucose was also lower after oral glucose, while hepatic glucose extraction remained unchanged. The incremental response of arterial glucose-dependent insulinotropic peptide, and of arterial and portal insulin, was comparable in Tx and sham rats; also in both groups the arterial response was significantly greater with oral versus i.v. glucose, and the incretin effect for insulin was intact after transplantation. Fecal fat and chymotrypsin levels did not differ between the two groups.


CONCLUSIONS
1) In the Tx rat lower incremental plasma glucose after oral glucose intake likely results from decreased intestinal glucose uptake; 2) preservation of a normal entero-insular axis of insulin together with the absence of intestinal malabsorption of lipids suggest that orthotopic transplantation of a duodeno-pancreas preserved endocrine and exocrine pancreatic function and therefore qualifies as treatment modality for the above named indications.
Kissler
H J
HJ
Department of Surgery, Friedrich Alexander University, Erlangen, Germany.
Gepp
H
H
Schwille
P O
PO
D000818:Animals; D001835:Body Weight; D004386:Duodenum / Q000637:transplantation*; D005951:Glucose Tolerance Test; D007108:Immune Tolerance / Q000502:physiology; D007328:Insulin / Q000032:analysis / Q000097:blood; D007515:Islets of Langerhans / Q000737:chemistry / Q000502:physiology; D008297:Male; D008954:Models, Biological; D018377:Neurotransmitter Agents / Q000032:analysis; D010179:Pancreas / Q000737:chemistry; D016035:Pancreas Transplantation / Q000502:physiology*; D051381:Rats; D011917:Rats, Inbred Lew; D017208:Rats, Wistar
D007328:Insulin; D018377:Neurotransmitter Agents