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Presenter: Duck Jong, Han, , Korea
Authors: Sung Shin, Chang Hee Jung, Ji Yoon Choi, Hyun Wook Kwon, Sung Jin Chun, Joo Hee Jung, Young Hoon Kim, Duck Jong Han
S. Shin1, C. Jung2, J. Choi1, H. Kwon1, S. Chun1, J. Jung1, Y. Kim1, D. Han1.
1Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, ; 2Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,
Background Limited data are available regarding a post-transplant improvement of β-cell function and insulin sensitivity of functioning pancreas transplants in patients with type 2 diabetes mellitus (T2DM) compared with type 1 diabetes mellitus (T1DM).
Methods To compare the metabolic effects of pancreas transplantation in terms of β-cell function and insulin sensitivity, comparison of metabolic variables was performed using oral glucose tolerance test between T1DM and T2DM patients pre-transplant and one month post-transplant.
Results Among 65 consecutive patients who underwent pancreas transplantation at our center between April, 2015 and December, 2016, a total of 29 patients (22 T1DM and 7 T2DM) were performed pre- and post-transplant oral glucose tolerance test. Insulinogenic index (0.693 ± 2.261 vs 0.035 ± 0.082, p = 0.186) and disposition index (2.363 ± 7.571 vs 0.364 ± 0.996, p = 0.237) in T1DM recipients were likely to increase post-transplant rather than pre-transplant but failed to get statistical significance. Insulin sensitivity determined by Matsuda’s index (3.825 ± 2.140 vs 8.686 ± 8.046, p = 0.015) was significantly decreased one month post-transplant rather than pre-transplant. Meanwhile, insulinogenic index (1.577 ± 2.533 vs 0.008 ± 0.118, p = 0.145) and disposition index (3.962 ± 6.441 vs 0.009 ± 0.262, p = 0.155) in T2DM recipients were also likely to increase post-transplant rather than pre-transplant. There was no significant difference in Matsuda’s index (3.700 ± 2.597 vs 5.034 ± 4.819, p = 0.604) between pre- and post-transplant. Post-transplant levels of serum glucagon significantly decreased compared with the levels pre-transplant when oral glucose tolerance test was performed.
Conclusions Neither in T1DM nor T2DM recipient, we could verify the improvement of insulin sensitivity one month post-transplant whereas β-cell function tended to improve in both. It is postulated that insulin sensitivity in early post-transplant period is influenced by high dose calcineurin inhibitor. Long-term follow up analysis is necessary to evaluate the beneficial effect of pancreas transplantation in terms of insulin sensitivity, especially in T2DM.
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