Effect of venous drainage site on insulin action after simultaneous pancreas-kidney transplantation.
BACKGROUND
The aim of the present study was to determine the influence of the venous drainage site on insulin homeostasis in simultaneous pancreas-kidney (SPK) transplant recipients.


METHODS
The study included 12 SPK patients with portal venous drainage (P) and 11 SPK patients with systemic venous drainage (S) of pancreas allograft. All of the participants presented similar characteristics. The euglycemic hyperinsulinemic clamp was performed using a 0.4-mU/kg/min insulin infusion. An infusion of [6,6-(2)H2] glucose was used to determine glucose turnover at the basal state and during the clamp to determine liver and peripheral tissue sensitivity to insulin.


RESULTS
Minor changes in glycemia and insulinemia were shown: fasting plasma glucose was significantly higher in the SPK-P group and insulinemia was higher in the SPK-S group. Hepatic glucose production was similar in both groups. During the clamp, insulin levels were higher in SPK-S recipients, but hepatic glucose production was suppressed in both groups. Glucose use was lower in SPK-S recipients than in SPK-P recipients, 3.32 +/-1.41 mg/kg/min and 4.70 +/-1.64 mg/kg/min, respectively (P<0.02). Basal and under-clamp free fatty acid levels were similar. In addition, no significant difference in cholesterol and low-density lipoprotein levels was shown, whereas high-density lipoprotein levels were higher in the SPK-S group; triglycerides during fasting and under clamp were significantly higher in the SPK-P group.


CONCLUSIONS
In both groups, neither hepatic nor peripheral insulin resistance was detected. In SPK-S recipients, the authors have showed only a lower insulin clearance and a slight decreased peripheral responsiveness to insulin without modifications of lipid status.
Petruzzo
Palmina
P
Department of Surgery and Transplantation, University of Cagliari, Cagliari, Italy.
Laville
Martine
M
Badet
Lionel
L
Lefrançois
Nicole
N
Bin-Dorel
Sylvie
S
Chapuis
François
F
Andreelli
Fabrizio
F
Martin
Xavier
X
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D004322:Drainage; D005215:Fasting; D005260:Female; D015309:Glucose Clamp Technique; D005951:Glucose Tolerance Test; D006801:Humans; D006946:Hyperinsulinism / Q000652:urine; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods* / Q000502:physiology; D011169:Portal Vein / Q000601:surgery*; D014184:Transplantation, Homologous
D001786:Blood Glucose; D008055:Lipids