Differing Effects of Pancreas-kidney Transplantation With Systemic Versus Portal Venous Drainage on Cholesteryl Ester Transfer in IDDM Subjects

Abstract

CET is affected by variations in systemic insulin levels in pancreas transplant patients with allografts that have differing venous drainage. Because high systemic insulin levels are linked to the activation of (ET, euglycemic HI IDDM pancreas allograft recipients may continue to be at high risk for macrovascular complications.

First World Consensus Conference on pancreas transplantation: Part II – recommendations

“…No study demonstrated that portal venous drainage increases surgical risk 187 , 229 , 230 , 231 , 232 , 233 , 234 , 235 but, on the other hand, no study showed either an immunologic, 199 , 207 , 208 , 229 , 236 or a metabolic advantage. 233 , 234 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 …”

Dyslipidemia in Type 1 Diabetes: A Masked Danger

“…Indeed, peripheral hyperinsulinemia has been shown to be responsible for increased LPL activity in patients with T1D (4), and it has been reported that LPL, in presence of VLDL, enhances CETP activity (35). Moreover, it has been shown that increased LPL and CETP activity in T1D patients returned to normal levels following intraperitoneal administration of insulin with an implantable insulin pump that mimics the physiologic portal route or after pancreatic graft (36,37).…”

A comparison of long‐term outcomes of portal versus systemic venous drainage in pancreatic transplantation: a systematic review and meta‐analysis

“…Three articles were excluded because the data were presented in a way where it could not be extracted for meta‐analysis . Two more articles each looked at different endpoints . One study only analyzed survival estimates using Kaplan–Meier estimates , and three papers were subset analyses which included only selected recipients, and therefore, none met inclusion criteria .…”

“…Beyond glycemic control, there are proposed improvements in lipid profiles. The proposed mechanism is related to the hyperinsulinemia seen in systemic venous drainage . However, recent experimentation demonstrates that despite the fasting peripheral hyperinsulinemia, levels of intrahepatic and intramuscular lipids were similar in systemically drained pancreas transplanted individuals compared to healthy volunteers .…”