title: Pancreas transplantation in C-peptide positive patients: does "type" of diabetes really matter?
abstract: BACKGROUND
  In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT).
  
  
  METHODS
  We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL.
  
  
  RESULTS
  From November 2001 to March 2013, we performed 162 SPKTs including 30 (18.5%) in patients with C-peptide levels ≥ 2.0 ng/mL pretransplantation (C-peptide positive group, range 2.1 to 12.4 ng/mL) and 132 in patients with absent or low C-peptide levels (<2.0 ng/mL, C-peptide "negative"). C-peptide positive patients were older at SPKT, had a later age of onset and shorter duration of pretransplantation DM, and more were African-American (all p < 0.05) compared with C-peptide negative patients. With a mean follow-up of 5.6 years, patient (80% vs 82.6%), kidney graft (63.3% vs 68.9%), and pancreas graft survivals (50% vs 62.1%, all p = NS) rates were comparable in C-peptide positive and negative patients, respectively. At latest follow-up, there were no differences in acute rejection episodes, surgical complications, major infections, readmissions, hemoglobin A1c levels, serum creatinine, and estimated glomerular filtration rate levels between the 2 groups. C-peptide levels were higher (mean 5.0 vs 2.6 ng/mL, p < 0.05) and post-transplant weight gain (≥ 5 kg) was more common (57% vs 33%, p = 0.004) in the C-peptide positive group. Survival outcomes in C-peptide positive (n = 14) vs C-peptide negative (n = 22) African-American patients were similar, as were outcomes in C-peptide positive patients with a body mass index < or ≥ 28 kg/m(2).
  
  
  CONCLUSIONS
  Patients with higher pretransplantion C-peptide levels appear to have a type 2 DM phenotype compared to insulinopenic patients undergoing SPKT. However, survival and functional outcomes were similar, suggesting that pretransplantation C-peptide levels should not be used exclusively to determine candidacy for SPKT.
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: rstratta@wakehealth.edu.
authors: Robert J
authors: RJ
authors: Stratta
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Jeffrey
authors: J
authors: Rogers
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Alan C
authors: AC
authors: Farney
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Giuseppe
authors: G
authors: Orlando
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Hany
authors: H
authors: El-Hennawy
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
authors: Michael D
authors: MD
authors: Gautreaux
authors: Department of Internal Medicine (Section of Nephrology), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Amber
authors: A
authors: Reeves-Daniel
authors: Department of Internal Medicine (Section of Nephrology), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Amudha
authors: A
authors: Palanisamy
authors: Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC.
authors: Samy S
authors: SS
authors: Iskandar
authors: Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
authors: Jason K
authors: JK
authors: Bodner
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002096:C-Peptide / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D016035:Pancreas Transplantation / Q000379:methods*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D002096:C-Peptide