Post transplantation hypoglycaemia in type 1 diabetic pancreas allograft recipients

Physiologic replacement of insulin in patients with type 1 (insulin-depende nt) diabetes following pancreas allograft transplantation results in normog lycaemia during fasting and postprandial states. However, this is achieved at the expense of peripheral hyperinsulinaemia in the heterotopic pancreas allograft recipients with systemic insulin drainage. In addition, the pancr eas allograft is denervated and thus devoid of autonomic nervous regulation of pancreatic beta-cell secretion. Recent reports of hypoglycaemia (sympto matic and asymptomatic), which can be fatal, have raised serious concerns r egarding the aetiology of the hypoglycaemic epiphenomon in type 1 diabetic pancreas allograft recipients. Although the prevalence of significant hypog lycaemia following pancreas transplantation remains unknown, it is importan t to conduct studies to determine the mechanisms, the natural history, pred ictors and treatment as well as the long-term prognosis (graft and patient survival rates) of type 1 diabetic patients who develop pancreas allograft- associated hypoglycaemia hypoglycaemia. Indeed, predictors of hypoglycaemia following pancreas allograft could significantly impact on the selection o f appropriate therapeutic options for pancreas allograft transplantation, F inally, whether postpancreas allograft transplantation-associated hypoglyca emia in type 1 diabetic patients carries greater morbidity and mortality wh en compared to those without hypoglycaemia deserves to be investigated.