B. Foger et al., EFFECT OF PANCREAS TRANSPLANTATION ON LIPOPROTEIN-LIPASE, POSTPRANDIAL LIPEMIA, AND HDL CHOLESTEROL, Transplantation, 58(8), 1994, pp. 899-904
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.