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Pancreas and kidney transplantation: long‐term endocrine function
Author(s) -
Mora Mireia,
Ricart María José,
Casamitjana Roser,
Astudillo Emiliano,
López Irela,
Jiménez Amanda,
FernándezCruz Laureano,
Esmatjes Enric
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2010.01261.x
Subject(s) - medicine , transplantation , endocrinology , pancreas transplantation , diabetes mellitus , kidney transplantation , dialysis , kidney disease , basal (medicine) , gastroenterology , hemoglobin , kidney , pancreas , urology
Mora M, Ricart MJ, Casamitjana R, Astudillo E, López I, Jiménez A, Fernández‐Cruz L, Esmatjes E. Pancreas and kidney transplantation: long‐term endocrine function.
Clin Transplant 2010: 24: E236–E240. © 2010 John Wiley & Sons A/S. Abstract: Objective: To describe the characteristics of metabolic control and beta‐cell function in the long‐term follow‐up of patients with type‐1 diabetes (T1D) who have undergone pancreas and kidney transplantation (PKTx). Patients and methods: Twelve patients (eight males/four females) with normal pancreas and kidney graft function for more than 15 yr were included. Patient age at the time of transplantation was 35.8 ± 6.9, with a duration of diabetes of 19.0 ± 4.6 yr and time on dialysis of 18.7 ± 12.4 months. In all the cases, bladder derivation was performed to drain exocrine secretion, with subsequent conversion to the intestinal tract in 42% of the patients. The functional evaluation was made at one, five, 10, and 15 yr after PKTx determining: glycosylated hemoglobin (HbA1c), oral glucose tolerance test (OGTT), measuring insulinemia, and anti‐GAD antibody. Results: Comparing the results between one and 15 yr after transplantation: (i) no differences were observed in either HbA1c (4.68% vs. 4.76%) or basal glycemia (71 vs. 79 mg/dL), but an increase was seen in the area under the curve (AUC) of glucose (11 983 vs. 15 875 mg/dL/120′, p = 0.02); (ii) a trend to a reduction in basal insulinemia (24 vs. 15 mU/L, p = 0.11) and a trend to a reduction in the AUC of insulinemia (8446 vs. 7057 mU/L/120′, p = 0.22) were observed. The OGTT was normal in six patients, intolerant in two and diabetic in four patients. No variations were seen in insulin resistance (FIRI, QUICKI). Anti‐GAD antibody became positive in one case. Conclusions: The results of this study demonstrate that pancreas transplantation has long‐term functional viability, being an essential strategy for the treatment of patients with T1D with end‐stage renal failure. Nevertheless, lesser response to OGTT can be expected suggesting certain deterioration in the functional capability of the pancreas graft during follow‐up.