Metabolic consequences of pancreatic systemic or portal venous drainage in simultaneous pancreas-kidney transplant recipients.
OBJECTIVE
The aim was to investigate pancreatic B-cell function and insulin sensitivity in simultaneous pancreas-kidney (SPK) recipients with systemic or portal venous drained pancreas allograft using simple and easy tests.


METHODS
The study included 44 patients with Type 1 diabetes and end-stage renal disease who had undergone SPK transplantation: 20 recipients received a pancreas allograft with systemic venous drainage (S-SPK) and 24 with portal venous drainage (P-SPK). We studied only recipients with functioning grafts, with normal serum glucose, HbA(1c) and serum creatinine values, on a stable drug regimen. The subjects were studied at 6, 12, 24, 36, 48 and 60 months after transplantation. Insulin sensitivity and B-cell function indices were derived from blood samples and oral glucose tolerance tests.


RESULTS
All patients from both groups had normal fasting glucose, body mass index and HbA(1c) values by selection. The homeostatic model (HOMA) beta-cell index was significantly lower in P-SPK recipients at several points of the follow-up. HOMA-IR was significantly higher in S-SPK recipients at 6 and 24 months after transplantation and was positively correlated with fasting insulin values, but never exceeded 3.2. There was no significant difference in QUICKI index values between the two groups. Although all patients from both groups always had normal glucose tolerance, the area under the insulin curve was higher in the S-SPK group. Cholesterol, low-density lipoprotein-cholesterol and triglycerides were higher in the P-SPK group.


CONCLUSIONS
The results suggest sustained long-term endocrine function in both groups and show that portal venous drainage does not offer major metabolic advantages.
Petruzzo
P
P
Department of Surgery, University of Cagliari, Cagliari, Italy. petruzzo@pacs.unica.it
Badet
L
L
Lefrançois
N
N
Berthillot
C
C
Dorel
S Bin
SB
Martin
X
X
Laville
M
M
D000328:Adult; D019540:Area Under Curve; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D010179:Pancreas / Q000098:blood supply*; D016035:Pancreas Transplantation; D011169:Portal Vein; D014184:Transplantation, Homologous; D014280:Triglycerides / Q000097:blood
D008078:Cholesterol, LDL; D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol