Metabolic characterization of long-term successful pancreas transplants in type I diabetes

R. Paul Robertson, David E.R. Sutherland, David M. Kendall, Adrian U. Teuscher, Rainer W.G. Gruessner, Angelika Gruessner

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Background: The encouraging results of the Diabetes Control and Complications Trial emphasize the need for improved methods of glycemic control to prevent the potentially devastating complications of Type I diabetes mellitus. However, current conventional approaches have failed to consistently achieve normal HbAlc levels and increase the risk of hypoglycemia. Pancreas transplantation is a consistently reliable method of achieving postoperative normal glucose levels, but no extensive assessment has been made of the long-term stability of its metabolic benefits. Methods: To ascertain long-term stability of metabolic function of pancreas transplants in Type I diabetic patients, we studied fasting glucose levels, glucose disposal after intravenous glucose challenge, HbAlc levels, and pancreatic islet beta and alpha cell responsiveness in a series of 96 successfully transplanted recipients. Patients were studied crosssectionally and, when possible, longitudinally for up to five years post-transplantation. Special emphasis was given to the longitudinal analysis to determine whether initial metabolic benefits maintain stability or undergo deterioration during the first five postoperative years. Results: Pancreas transplantation was accompanied by normal or nearly normal fasting plasma glucose levels, intravenous glucose disappearance rates, and HbAlc levels. Beta cell function assessed by acute insulin responses and acute C-peptide responses to intravenous glucose injections revealed no deterioration in the magnitude of these responses. Analysis of acute insulin and C-peptide responses to intravenous arginine provided similar results. Alpha cell function, assessed by measuring acute glucagon responses to intravenous arginine, were significantly (p > .001) greater than preoperative responses and remained stable over the ensuing five-year period. In grafts that maintained function, none of these metabolic measures showed deterioration during the five-year postoperative period. Conclusions: Successful pancreas transplantation provides pancreatic islet function that results in normal or near normal glycemic control for up to five years postoperatively in Type I diabetic recipients receiving no exogenous insulin or oral hypoglycemic agent therapy.

Original languageEnglish (US)
Pages (from-to)549-555
Number of pages7
JournalJournal of Investigative Medicine
Volume44
Issue number9
StatePublished - 1996

Keywords

  • Five-year follow-up
  • Metabolic stability
  • Pancreas transplants
  • Type I diabetes

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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