Long-term metabolic control in recipients of combined pancreas and kidney transplants

Abstract

Summary. Metabolic glucose control was followed in 36 patients at 12-month intervals for up to 5 years after a successful combined kidney and segmental duct-occluded pancreas transplantation. All recipients had normal blood glucose levels at each examination. HbA1 values, intravenous glucose tolerance test, C-peptide levels and C-peptide responses to glucagon stimulation were also, on average, within the normal range. Several individual patients had, however, abnormal values for these parameters. At most 46% had abnormal values for HbA1 and intravenous glucose tolerance test, up to 13% showed low C-peptide values and up to 46% of the stimulated C-peptide responses were inadequate at the different intervals. These parameters did not deteriorate with time. This was true both for the whole group of patients as well as for the 6 patients with a 5-year observation time evaluated separately. Despite these abnormalities in glucose metabolism, all patients remained normoglycaemic without need for exogenous insulin up to 5 years after transplantation. The long-term ability of duct-occluded segmental pancreatic grafts to preserve euglycaemia therefore seems to remain intact at least for 5 years.

Pancreas and kidney transplantation: long‐term endocrine function

“…During the 15‐yr follow‐up of the present study, PTx showed long‐term viability, which was clearly demonstrated by the serial measurement of HbA1c. Similar to the results of other authors (5–7, 14–16), HbA1c remained within the normal range during the follow‐up as did fasting glycemia, thereby supporting the role of PTx in maintaining strict metabolic control over a long period of time. However, a worsening in this profile was observed after OGTT, showing deterioration in beta‐cell function after stimulus.…”

“…The duration of pancreas function following transplantation is of great importance in the therapeutic approach to patients with T1D with end‐stage renal failure. Up to now, little information has been available regarding the long‐term metabolic consequences of PTx, especially in combined PKTx (5, 7), although several studies have described long‐term pancreas graft survival (1, 3, 4, 10–13) according to HbA1c values.…”

“…In a five‐yr follow‐up in the study by Holdaas et al. (5), fasting glucose levels were within the normal range with abnormal glycosylated hemoglobin (HbA1c) values in 46% of patients. Although the functional capacity of pancreas transplantation (PTx) has been clearly demonstrated after 10 yr of follow‐up (6, 7), data related to metabolic function in patients with a longer survival are scarce.…”

Development of Islet‐Like Cell Clusters After Pancreas Transplantation in the Spontaneously Diabetic Torri Rat

“…PTx can reestablish an autonomous and self‐regulated source of insulin for secretion, and correct and adapt the delivery of hormone according to moment‐to‐moment metabolic necessities (20), resulting in a long‐term normalization or near‐normalization of the metabolic abnormalities of diabetes (21,22). Although tight glycemic control may also be achieved by intensive insulin treatment, the price is rigorous self‐discipline plus an increased frequency of insulin reactions and hypoglycemic episodes (23).…”