Index High Insulin Resistance in Pancreas–Kidney Transplantation Contributes to Poor Long-term Survival of the Pancreas Graft

• Published in: Transplantation proceedings Vol. 47; no. 1; pp. 117 - 119
• Main Authors: Pendón-Ruiz de Mier, V, Navarro Cabello, M.D, Martínez Vaquera, S, Lopez-Andreu, M, Aguera Morales, M.L, Rodriguez-Benot, A, Ruiz Rabelo, J, Campos Hernandez, P, Requena Tapia, M.J, Aljama Garcia, P
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2015
• Subjects: Adult; Blood Glucose - analysis; Body Mass Index; Female; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; Glycemic Index - physiology; Graft Survival; Humans; Insulin - blood; Insulin Resistance; Insulin-Secreting Cells - metabolism; Kidney Failure, Chronic - surgery; Kidney Transplantation; Male; Middle Aged; Pancreas - metabolism; Pancreas Transplantation; Peptides - analysis; Proteinuria; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.11.024

Abstract Background Pancreas-kidney transplantation (PKT) is the best therapeutic option for diabetic patients with end-stage renal failure. Peripheral insulin resistance and the percentage of remaining β-cells in the PKT have been little studied in medical literature. Methods We analyzed PKT performed in our hospital from January 1992 to January 2014, with follow-up for 5 years. Metabolic values related to glycemic were studied, namely, proteinuria, peptide C, glucose, insulin, and glycosylated hemoglobin. We analyzed insulin resistance (homeostatic model assessment [HOMA]-IR), the percentage of remaining β-cells (HOMA-β), and the influence of these variables on the glycemic profile and graft survival. Results In the study period, 156 simultaneous PKT were performed in our center. At 2 years posttransplantation, the median value of HOMA-IR kidney–pancreas was 4. We compared transplantation with lower HOMA-IR (<4) and higher HOMA-IR (>4). HOMA-β (36 [26–67] vs 29 [14–42]; P  = .04), glucose (86 [80–90] vs 81 [74–89]; P  = .018), and body mass index (BMI; 24 [21–27] vs 21 [19–24]; P  = .013) were greater in the group HOMA-IR>4 versus HOMA-IR<4 group, respectively, after 3 months. These differences in glycemic profile were maintained until the first year after transplantation. At 2 and 5 years of follow-up, the HOMA-IR>4 group showed higher glucose levels and greater BMI, but not differences in HOMA-β. At 1 and 5 years posttransplantation, pancreatic graft survival in the HOMA-IR>4 group (82.9% vs 92.5%) was lower compared with the HOMA-IR<4 group (67% vs 87.5%; P  = .016). Conclusions PKT exhibit an altered glycemic profile in the posttransplantation follow-up associated with the percentage of remaining β-cells and peripheral insulin resistance. PKT patients with peripheral insulin resistance showed decreased pancreatic graft survival.