EFFECTS OF SYSTEMIC DELIVERY OF INSULIN ON PLASMA-LIPIDS AND LIPOPROTEIN CONCENTRATIONS IN PANCREAS TRANSPLANT RECIPIENTS

Objective: To determine whether pancreas transplantation alters lipid and lipoprotein concentrations and whether peripheral hyperinsulinemia is always associated with altered lipid levels. Design: We assessed t he lipid profiles of seven pancreas-kidney recipients with insulin-dep endent diabetes mellitus, seven kidney recipients without diabetes who received the same immunosuppressive agents, and eight normal subjects . Material and Methods: In the three study groups, fasting and postpra ndial plasma glucose, insulin, C-peptide, cholesterol, triglyceride, f ree fatty acid, and apolipoprotein A-I, A-II, C-II, and C-III concentr ations were determined. Results: Pasting and postprandial glucose conc entrations did not differ between the two, transplant groups; however, peripheral insulin concentrations were twice as high (P<0.05) in the pancreas-kidney recipients as in the kidney recipients both before (10 2 +/- 15 versus 53 +/- 6 pmol/L) and after (123 +/- 22 versus 61 +/- 6 nmol/L per 6 hours) ingestion of a meal. Preprandial and postprandial insulin levels in both transplant groups also were greater (P<0.05) t han those in normal subjects (35 +/- 6 pmol/L and 40 +/- 7 nmol/L per 6 hours, respectively). Despite significant differences in insulin con centrations, no differences mere noted in total cholesterol, high-dens ity or low-density lipoprotein cholesterol, plasma free fatty acids, o r apolipoprotein A-I, A-II, C-II, and C-III concentrations among the s tudy groups. Plasma triglyceride concentrations in the two transplant groups were similar (114 +/- 20 versus 142 +/- 18 mg/dL) and were slig htly more than those in the normal subjects (80 +/- 7 mg/dL). Conclusi on: Despite peripheral hyperinsulinemia, pancreas transplantation can result in normal or near-normal lipid and lipoprotein concentrations. Thus, systemic delivery of insulin does not invariably produce an athe rogenic lipid profile.