EFFECT OF PANCREAS TRANSPLANTATION ON LIPOPROTEIN-LIPASE, POSTPRANDIAL LIPEMIA, AND HDL CHOLESTEROL

Pancreas transplantation with systemic venous drainage of the graft ca uses elevated plasma levels of insulin, known to be a potent regulator of plasma lipoprotein metabolism. We studied 11 post-type I diabetic pancreas-kidney transplant recipients, 9 type I diabetic kidney transp lant recipients displaying peripheral hyperinsulinemia due to subcutan eous insulin treatment, 11 nondiabetic kidney transplant recipients as controls for the effects of immunosuppressive medication, and 11 heal thy control subjects, all matched for age, sex, and body mass index. W e determined fasting lipids, lipoproteins and lipolytic enzymes, as we ll as postprandial lipid metabolism after a standardized oral fat load . High-density lipoprotein (HDL) cholesterol averaged 1.98 (0.40) mmol /L in pancreas-kidney transplant patients, clearly higher than that of kidney transplant recipients (1.52 (0.36) mmol/L, P<0.05) or of contr ols (1.50 (0.38) mmol/L, P<0.05). In pancreas-kidney transplant patien ts postprandial lipemia was lowest and lipoprotein lipase activity was highest (average 32% and 154%, respectively, of the mean of the contr ols) compared with nondiabetic kidney transplant recipients (P<0.005, P<0.05) and healthy controls (P<0.001, P<0.01). In type I diabetic kid ney transplant recipients the levels of HDL cholesterol (1.88 (0.63) m mol/L), postprandial lipemia, and lipoprotein lipase activity were int ermediate between pancreas-kidney transplant patients and healthy cont rols. The distinctly elevated HDL cholesterol in pancreas-kidney trans plant patients can be readily explained by the low postprandial trigly ceride levels resulting from a high activity of lipoprotein lipase. Th e very favorable lipid profile in post-diabetic pancreas-kidney transp lant recipients could be expected to counteract the severe atheroscler otic risk of long-standing diabetes.