Effects of pancreas transplantation on postprandial glucose metabolism

Harold Katz, Mal Homan, Jorge Velosa, Paul Robertson, Robert Rizza

Research output: Contribution to journalArticle

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Abstract

Background. Because a pancreas allograft is placed in the pelvis, pancreas transplantation abolishes the normal gradient between portal-vein and peripheral-vein insulin concentrations and causes systemic hyperinsulinemia. Whether pancreas transplantation restores carbohydrate metabolism to normal is not known. Methods. We studied seven patients with insulin-dependent diabetes mellitus after pancreas-kidney transplantation, seven nondiabetic patients after kidney transplantation (to control for immunosuppression), and eight normal subjects. Measurements were made after an overnight fast and after ingestion of a mixed meal. Results. Although plasma glucose concentrations did not differ in the two transplant groups, plasma insulin concentrations were significantly higher in the diabetic pancreas-kidney recipients than in the nondiabetic kidney recipients, both before the meal (mean ±SE, 102±15 vs. 53±6 pmol per liter; P<0.05) and afterward (123±22 vs. 61±6 nmol per liter per six hours; P<0.05). Plasma C-peptide concentrations were the same in both groups, indicating that hyperinsulinemia was due to decreased insulin clearance rather than increased insulin secretion. Despite drainage of the venous effluent from the transplanted pancreas into the systemic circulation, the values for splanchnic clearance of ingested glucose, suppression of hepatic glucose release, incorporation of carbon dioxide into glucose, stimulation of glucose oxidation, glucose uptake, and forearm glucose clearance were all similar in the transplant groups and differed minimally from the values in the normal group. The similar rates of glucose uptake in the presence of higher systemic insulin concentrations indicated that the extrahepatic tissues of the diabetic pancreas-kidney recipients were insulin-resistant. Conclusions. Despite systemic delivery of insulin, pancreas-kidney transplantation in patients with diabetes results in carbohydrate metabolism similar to that in nondiabetic subjects receiving the same immunosuppressive agents after kidney transplantation.

Original languageEnglish (US)
Pages (from-to)1278-1283
Number of pages6
JournalNew England Journal of Medicine
Volume325
Issue number18
StatePublished - Oct 31 1991

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Pancreas Transplantation
Glucose
Insulin
Kidney Transplantation
Pancreas
Carbohydrate Metabolism
Hyperinsulinism
Kidney
Meals
Splanchnic Circulation
Transplants
C-Peptide
Immunosuppressive Agents
Portal Vein
Pelvis
Type 1 Diabetes Mellitus
Forearm
Carbon Dioxide
Immunosuppression
Allografts

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Katz, H., Homan, M., Velosa, J., Robertson, P., & Rizza, R. (1991). Effects of pancreas transplantation on postprandial glucose metabolism. New England Journal of Medicine, 325(18), 1278-1283.

Effects of pancreas transplantation on postprandial glucose metabolism. / Katz, Harold; Homan, Mal; Velosa, Jorge; Robertson, Paul; Rizza, Robert.

In: New England Journal of Medicine, Vol. 325, No. 18, 31.10.1991, p. 1278-1283.

Research output: Contribution to journalArticle

Katz, H, Homan, M, Velosa, J, Robertson, P & Rizza, R 1991, 'Effects of pancreas transplantation on postprandial glucose metabolism', New England Journal of Medicine, vol. 325, no. 18, pp. 1278-1283.
Katz H, Homan M, Velosa J, Robertson P, Rizza R. Effects of pancreas transplantation on postprandial glucose metabolism. New England Journal of Medicine. 1991 Oct 31;325(18):1278-1283.
Katz, Harold ; Homan, Mal ; Velosa, Jorge ; Robertson, Paul ; Rizza, Robert. / Effects of pancreas transplantation on postprandial glucose metabolism. In: New England Journal of Medicine. 1991 ; Vol. 325, No. 18. pp. 1278-1283.
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