Metabolic follow-up after long-term pancreas graft survival

Abstract

Design: Successful pancreas transplantation results in insulin independence and normoglycemia. This prospectivestudywasperformedtoinvestigatelong-termmetabolicchangesafterpancreastransplantation. Methods: Thirty-eight type 1 diabetic patients after simultaneous pancreas/kidney transplantation (SPK) with a pancreas graft survival for at least 10 years were studied in a prospective manner. HbA 1c and glucose levels before and duringan oral glucose tolerance test (OGTT) were analyzed from 3 months to 10 years after SPK. In addition, insulin secretion and glucagon response were measured. Results: Fastingglucose increased slightlyand continuously from 3 months to 10 years (from 78G3to91G 2 mg/dl). Even HbA 1c levels showed a mild but significant increase from 3 months to 10 years after SPK. Glucose tolerance deteriorated markedly 10 years after SPK. Insulin secretion during OGTT remained stable for 10 years. Parameters of insulin resistance and sensitivity did not change significantly but glucagon secretion increased significantly during the course after SPK. Late after SPK, glucagon levels were higher in patients with an impaired or diabetic glucose tolerance. Conclusions: Pancreas transplantation is able to restore endogenous insulin secretion for 10 years or more. Especially, late after SPK, a deterioration of glycemic control was detected, even if glucose values were within the normal range. During prospective long-term follow-up, an increase of glucagon secretion but no decrease of insulin secretion was detected.European Journal of Endocrinology 156 603-610

Current and Emerging Treatment Options in Diabetes Care

“…Improvements in transplantation surgery and immunosuppressive therapy are reflected in a >95% 1-year survival rate and graft survival of close to 85% (Gruessner and Gruessner 2012). Importantly, a successful transplant is more efficient in lowering HbA1c levels and maintaining glycemic control than insulin therapy (Dieterle et al 2007). An alternative to pancreatic transplantation is the less invasive islet transplants.…”

Indikation und Ergebnisse der simultanen Nieren-Pankreas-Transplantation

“…Diese Erkenntnisse wur den in vielfältigen weiteren Untersuchun gen von anderen Autoren bestätigt [3,8,12,13,14,25].…”

Pankreas- und Inselzelltransplantation

“…Gleichzeitig werden akute Komplikationen des Diabetes mellitus, wie hyper-und hypoglykämische Entgleisungen beseitigt. Bei erfolgreicher Pankreastransplantation bleiben die Glukose-und HbA1c-Spiegel sowie die Insulinsekretion über 10 Jahre und mehr stabil [8]. Am Münchner Transplantationszentrum konnten wir kürzlich über 38 bzw.…”