Summary
Long-term metabolic control after pancreatic transplantation with enteric exocrine diversion was evaluated in 42 Type I (insulin-dependent) diabetic pancreas recipients with functioning grafts for 1 to 7 years. Glycaemic control (fasting blood glucose, glycosylated haemoglobin A1c, oral and intravenous glucose tolerance tests) was normal or near-normal in most patients, and showed no deterioration with time. In ten patients with functioning grafts for 5 years there was a small, but significant, improvement in the glucose control at 3 to 5 years as compared with that at 6 months post-operatively. In the latter recipients the number of acute rejection episodes correlated negatively with the intravenous glucose tolerance at 6 months (r=−0.64, p<0.01) and at 5 years (r=−0.60, p<0.01) after transplantation, respectively. The glycaemic control at 6 and 12 months after transplantation was similar whether segmental (n=35) or whole-organ (n=7) pancreatic grafts had been used. In six non-uraemic recipients who had received a pancreas transplant alone the serum cholesterol increased in all but one patient (0.05<p<0.1), and the LDL/HDL-cholesterol ratio was significantly higher (p<0.005) one year after transplantation than before. Conversely, in six diabetic patients who had lost the function of their single pancreatic grafts the lipid and lipoprotein profiles remained unaltered. It is concluded that the long-term glycaemic control after segmental or whole-organ pancreatic transplantation with enteric exocrine diversion remains essentially normal in most recipients, and it may even improve with time. The short- and long-term glucose control seems to be adversely influenced by the number of acute rejections. Moreover, in non-uraemic pancreas transplant recipients the lipoprotein profile changed towards a more atherogenic pattern. The latter findings are probably attributable to the immunosuppressive therapy.
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AbdElkader MW, Tydén G, Bolinder J, Groth CG (1990) Exocrine and endocrine function of pancreaticoduodenal grafts versus segmental pancreatic grafts. Transpl Proc 22:1593–1594
Bolinder J, Tydén G (1989) Indication, selection of patients and timing for pancreatic transplantation. In: Creutzfeldt W, Pichlmayr R (eds). Liver and pancreas transplantation. Baillière's Clinical Gastroenterology, Baillière Tindall, London Philadelphia Sydney Tokyo Toronto, 3:825–834
Carlsson K (1973) Lipoprotein fractionation. J Clin Pathol 5 (Suppl 5):32–37
Casaretto A, Marchioro TL, Goldsmith R, Bagdade JD (1974) Hyperlipidaemia after renal transplantation. Lancet i:481–484
Harris KPG, Russel GI, Parvin SD, Veitch PS, Walls J (1986) Alterations in lipid and carbohydrate metabolism attributable to cyclosporine A in renal transplant recipients. Br Med J 292:216
Ikkos D, Luft R (1957) On the intravenous tolerance test. Acta Endocrinol (Cph) 25:312–334
Landgraf R, Nusser J, Scheuer R, Fiedler A, Scheider A, Meyer-Schwickerath E, Müller-Felber W, Illner WD, Abendroth D, Land W (1989) Metabolic control and effect on secondary complications of diabetes mellitus by pancreatic transplantation. In: Creutzfeldt W, Pichlmayr R (eds) Liver and pancreas transplantation. Baillière's Clinical Gastroenterology. Baillière Tindall, London Philadelphia Sydney Tokyo Toronto, 3:865–876
LaRocca E, Martin X, Secchi A, Lefrancois N, Martinenghi S, Melandri M, Touraine JL, Pozza G, Dubernard JM (1990) Whole versus segmental pancreas graft: two years metabolic results. Transpl Proc 22:653–654
Martin X, Dubernard JM, Sanseverino R, Melandri M, Faure JL, Camozzi L, Lefrancois N, La Rocca E, Gelet A (1989) Segmental duct-obstructed pancreas grafts versus pancreaticoduodenal grafts with enteric diversion. Diabetes 38 (Suppl 7): 16–17
Östman J, Gunnarsson R, Groth CG (1988) Metabolic control after pancreas transplantation. In: Groth CG (ed) Pancreatic transplantation. WB Saunders, Philadelphia London Toronto Montreal Sydeny Tokyo, pp 291–314
Tibell A, Linder R, Larsson M, Tydén G, Groth CG, Bolinder J, Östman J (1990) Long-term glucose control after pancreatic transplantation. Transpl Proc 22:645–646
Tydén G, Bolinder J (1989) Surgical techniques and results in pancreatic transplantation. In: Creutzfeldt W, Pichlmayr R (eds) Liver and pancreas transplantation. Baillière's Clinical Gastroenterology. Baillière Tindall, London Philadelphia Sydney Tokyo Toronto, 3:835–850
Tydén G, Brattström C, Gunnarsson R, Lundgren G, Öst L, Östman J, Groth CG (1987) Metabolic control at two months to 4.5 years after pancreatic transplantation with special reference to the role of cyclosporine. Transpl Proc 19:2294–2296
Tydén G, Tibell A, Bolinder J, Östman J, Groth CG (1991) The Stockholm experience with pancreatic transplantation using enteric exocrine diversion. Diabetologia 34: (Suppl. 2)
World Health Organization (1985) Diabetes mellitus. Report of a WHO study group. Technical report series no 727
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Bolinder, J., Tydén, G., Tibell, A. et al. Long-term metabolic control after pancreas transplantation with enteric exocrine diversion. Diabetologia 34 (Suppl 1), S76–S80 (1991). https://doi.org/10.1007/BF00587625
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DOI: https://doi.org/10.1007/BF00587625