Functional beta-cell mass and insulin sensitivity is decreased in insulin-independent pancreas-kidney recipients.
BACKGROUND
To compare functional beta-cell mass and insulin sensitivity in insulin-independent pancreas-kidney recipients with that in age- and body mass index-matched nondiabetic kidney recipients and normal controls.


METHODS
All transplant recipients were on maintenance immunosuppression with mycophenolate mofetil and tacrolimus since more than 2.7 years (2.2-3.8 years). Their C-peptide release was measured during a 170-min hyperglycemic clamp, first in absence and then in presence of glucagon. Data were compared with those after glucose stimulation alone. Insulin sensitivity under basal and stimulated conditions was calculated using homeostasis model assessment of insulin resistance and insulin sensitivity index, respectively.


RESULTS
Functional beta-cell mass in pancreas-kidney recipients with systemic venous drainage was reduced, representing, respectively, 63% and 80% of that in healthy controls and kidney recipients. Pancreas-kidney recipients exhibited lower insulin sensitivity than healthy controls (homeostasis model assessment of insulin resistance was 0.8, 0.7-1.1 vs. 0.4, 0.3-0.8; P=0.02 and insulin sensitivity index was 17, 12-24 mg/kg/min per 100 microU/mL vs. 31, 20-38 mg/kg/min per 100 microU/mL; P=0.04).


CONCLUSIONS
Using a hyperglycemic clamp, the functional beta-cell mass in insulin-independent pancreas-kidney recipients was found to be 37% and 20% lower than in healthy controls and nondiabetic kidney recipients.
Gillard
Pieter
P
Department of Diabetology, Diabetes Research Center and University Hospital Brussels, Brussels Free University-VUB, Brussels, Belgium.
Vandemeulebroucke
Evy
E
Keymeulen
Bart
B
Pirenne
Jacques
J
Maes
Bart
B
De Pauw
Pieter
P
Vanrenterghem
Yves
Y
Pipeleers
Daniel
D
Mathieu
Chantal
C
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D015309:Glucose Clamp Technique; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D050417:Insulin-Secreting Cells / Q000166:cytology*; D007674:Kidney Diseases / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000379:methods*; D012016:Reference Values
D001786:Blood Glucose; D002096:C-Peptide; D003404:Creatinine; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D007328:Insulin