Pancreas and kidney transplantation: long-term endocrine function.
OBJECTIVE
To describe the characteristics of metabolic control and beta-cell function in the long-term follow-up of patients with type-1 diabetes (T1D) who have undergone pancreas and kidney transplantation (PKTx).


METHODS
Twelve patients (eight males/four females) with normal pancreas and kidney graft function for more than 15 yr were included. Patient age at the time of transplantation was 35.8 ± 6.9, with a duration of diabetes of 19.0 ± 4.6 yr and time on dialysis of 18.7 ± 12.4 months. In all the cases, bladder derivation was performed to drain exocrine secretion, with subsequent conversion to the intestinal tract in 42% of the patients. The functional evaluation was made at one, five, 10, and 15 yr after PKTx determining: glycosylated hemoglobin (HbA1c), oral glucose tolerance test (OGTT), measuring insulinemia, and anti-GAD antibody.


RESULTS
Comparing the results between one and 15 yr after transplantation: (i) no differences were observed in either HbA1c (4.68% vs. 4.76%) or basal glycemia (71 vs. 79 mg/dL), but an increase was seen in the area under the curve (AUC) of glucose (11,983 vs. 15,875 mg/dL/120', p = 0.02); (ii) a trend to a reduction in basal insulinemia (24 vs. 15 mU/L, p = 0.11) and a trend to a reduction in the AUC of insulinemia (8446 vs. 7057 mU/L/120', p = 0.22) were observed. The OGTT was normal in six patients, intolerant in two and diabetic in four patients. No variations were seen in insulin resistance (FIRI, QUICKI). Anti-GAD antibody became positive in one case.


CONCLUSIONS
The results of this study demonstrate that pancreas transplantation has long-term functional viability, being an essential strategy for the treatment of patients with T1D with end-stage renal failure. Nevertheless, lesser response to OGTT can be expected suggesting certain deterioration in the functional capability of the pancreas graft during follow-up.
Mora
Mireia
M
Department of Endocrinology and Nutrition, Hospital Clínic i Universitari of Barcelona, Barcelona, Spain. mporta@clinic.ub.es
Ricart
María José
MJ
Casamitjana
Roser
R
Astudillo
Emiliano
E
López
Irela
I
Jiménez
Amanda
A
Fernández-Cruz
Laureano
L
Esmatjes
Enric
E
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000601:surgery*; D004703:Endocrine System / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007668:Kidney / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D010179:Pancreas / Q000502:physiology; D016035:Pancreas Transplantation; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin