THE EFFECT OF VENOUS DRAINAGE ON GLUCOSE-HOMEOSTASIS AFTER EXPERIMENTAL PANCREAS TRANSPLANTATION

In this canine study, glucose homeostasis after clinical pancreas tran splantation is complex, with the relative effect of systemic versus po rtal delivery of insulin remaining unresolved. Thirty-two pancreatecto mized dogs received either systemic venous drainage (SVD) with bladder exocrine drainage (n=16), or portal venous drainage (PVD) with gastri c exocrine drainage (n=16). Cyclosporine (CsA) based immunosuppression was commenced on day -7. The effect of immunosuppression was a signif icant increase in fasting blood glucose (FBGL) (P=0.002), fasting insu lin (P=0.024), AUC for insulin (P=0.009), and K values decreased (P=0. 009). FBGL and K values remained abnormal after transplantation with n o significant difference seen between SVD and PVD. However, fasting in sulin became significantly lower after PVD and AUC insulin fell in bot h groups. CsA levels fell in both groups after transplantation, mirror ing the fall in AUC insulin, and implicating CsA as a major cause of p eripheral resistance to insulin. In conclusion, PVD did not demonstrat e a significant advantage over SVD in handling an intravenous glucose challenge. The need for pancreatectomy in large animals may make them an unsatisfactory experimental model to evaluate the glucoregulatory e ffects of pancreas allotransplantation.