title: Index high insulin resistance in pancreas-kidney transplantation contributes to poor long-term survival of the pancreas graft.
abstract: BACKGROUND
  Pancreas-kidney transplantation (PKT) is the best therapeutic option for diabetic patients with end-stage renal failure. Peripheral insulin resistance and the percentage of remaining β-cells in the PKT have been little studied in medical literature.
  
  
  METHODS
  We analyzed PKT performed in our hospital from January 1992 to January 2014, with follow-up for 5 years. Metabolic values related to glycemic were studied, namely, proteinuria, peptide C, glucose, insulin, and glycosylated hemoglobin. We analyzed insulin resistance (homeostatic model assessment [HOMA]-IR), the percentage of remaining β-cells (HOMA-β), and the influence of these variables on the glycemic profile and graft survival.
  
  
  RESULTS
  In the study period, 156 simultaneous PKT were performed in our center. At 2 years posttransplantation, the median value of HOMA-IR kidney-pancreas was 4. We compared transplantation with lower HOMA-IR (<4) and higher HOMA-IR (>4). HOMA-β (36 [26-67] vs 29 [14-42]; P = .04), glucose (86 [80-90] vs 81 [74-89]; P = .018), and body mass index (BMI; 24 [21-27] vs 21 [19-24]; P = .013) were greater in the group HOMA-IR>4 versus HOMA-IR<4 group, respectively, after 3 months. These differences in glycemic profile were maintained until the first year after transplantation. At 2 and 5 years of follow-up, the HOMA-IR>4 group showed higher glucose levels and greater BMI, but not differences in HOMA-β. At 1 and 5 years posttransplantation, pancreatic graft survival in the HOMA-IR>4 group (82.9% vs 92.5%) was lower compared with the HOMA-IR<4 group (67% vs 87.5%; P = .016).
  
  
  CONCLUSIONS
  PKT exhibit an altered glycemic profile in the posttransplantation follow-up associated with the percentage of remaining β-cells and peripheral insulin resistance. PKT patients with peripheral insulin resistance showed decreased pancreatic graft survival.
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain. Electronic address: mvitoriaprm@gmail.com.
authors: V
authors: V
authors: Pendón-Ruiz de Mier
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: M D
authors: MD
authors: Navarro Cabello
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: S
authors: S
authors: Martínez Vaquera
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: M
authors: M
authors: Lopez-Andreu
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: M L
authors: ML
authors: Aguera Morales
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: A
authors: A
authors: Rodriguez-Benot
authors: Department of General Surgery, H.U. Reina Sofía, Córdoba, Spain.
authors: J
authors: J
authors: Ruiz Rabelo
authors: Department of Urology, H.U. Reina Sofía, Córdoba, Spain.
authors: P
authors: P
authors: Campos Hernandez
authors: Department of Urology, H.U. Reina Sofía, Córdoba, Spain.
authors: M J
authors: MJ
authors: Requena Tapia
authors: Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
authors: P
authors: P
authors: Aljama Garcia
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index / Q000502:physiology*; D006085:Graft Survival; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D016035:Pancreas Transplantation; D010455:Peptides / Q000032:analysis; D011507:Proteinuria
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D010455:Peptides; C050632:polypeptide C