Pancreas Transplantation in C-Peptide Positive Patients: Does “Type” of Diabetes Really Matter?

• Published in: Journal of the American College of Surgeons Vol. 220; no. 4; pp. 716 - 727
• Main Authors: Stratta, Robert J., MD, FACS, Rogers, Jeffrey, MD, FACS, Farney, Alan C., MD, PhD, Orlando, Giuseppe, MD, PhD, El-Hennawy, Hany, MD, Gautreaux, Michael D., PhD, Reeves-Daniel, Amber, DO, Palanisamy, Amudha, MD, Iskandar, Samy S., MBBCh, PhD, Bodner, Jason K., MMS, PA-C
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adult; Biomarkers - blood; C-Peptide - blood; Diabetes Mellitus - blood; Diabetes Mellitus - mortality; Diabetes Mellitus - surgery; Disease Progression; Female; Follow-Up Studies; Graft Survival; Humans; Male; North Carolina - epidemiology; Pancreas Transplantation - methods; Preoperative Period; Prognosis; Retrospective Studies; Surgery; Survival Rate - trends; North Carolina; ESRD; SPKT; T1DM; type 1 diabetes mellitus; T2DM; body mass index; IPTR; DM; diabetes mellitus; pancreas transplantation; end-stage renal disease; simultaneous pancreas-kidney transplantation; DWFG; PTx; type 2 diabetes mellitus; death with a functioning graft; International Pancreas Transplant Registry; BMI
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2014.12.020

Background In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). Study Design We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥2.0 ng/mL or < 2.0 ng/mL. Results From November 2001 to March 2013, we performed 162 SPKTs including 30 (18.5%) in patients with C-peptide levels ≥2.0 ng/mL pretransplantation (C-peptide positive group, range 2.1 to 12.4 ng/mL) and 132 in patients with absent or low C-peptide levels (<2.0 ng/mL, C-peptide “negative”). C-peptide positive patients were older at SPKT, had a later age of onset and shorter duration of pretransplantation DM, and more were African-American (all p < 0.05) compared with C-peptide negative patients. With a mean follow-up of 5.6 years, patient (80% vs 82.6%), kidney graft (63.3% vs 68.9%), and pancreas graft survivals (50% vs 62.1%, all p = NS) rates were comparable in C-peptide positive and negative patients, respectively. At latest follow-up, there were no differences in acute rejection episodes, surgical complications, major infections, readmissions, hemoglobin A1c levels, serum creatinine, and estimated glomerular filtration rate levels between the 2 groups. C-peptide levels were higher (mean 5.0 vs 2.6 ng/mL, p < 0.05) and post-transplant weight gain (≥5 kg) was more common (57% vs 33%, p = 0.004) in the C-peptide positive group. Survival outcomes in C-peptide positive (n = 14) vs C-peptide negative (n = 22) African-American patients were similar, as were outcomes in C-peptide positive patients with a body mass index < or ≥ 28 kg/m2. Conclusions Patients with higher pretransplantion C-peptide levels appear to have a type 2 DM phenotype compared to insulinopenic patients undergoing SPKT. However, survival and functional outcomes were similar, suggesting that pretransplantation C-peptide levels should not be used exclusively to determine candidacy for SPKT.