Pancreas and kidney transplantation: metabolic long term results.

Study aim: Pancreas and kidney transplantation (PKTx) is indicated in uremi c patients with insulin-dependent diabetes mellitus (IDDM). The aim of this study was to determine its long-term effect on metabolic control in order to establish the real efficacy of this treatment in diabetic patients. Patients and method: Among a total experience of 191 pancreas and kidney tr ansplantations, a metabolic control was performed in 80 patients who underw ent PKTx in our center, with both grafts functioning for more than one year . Immunological markers of diabetes mellitus were also evaluated (ICA and G ADab) in 50 patients. Results: Basal glycemia and glycosilated hemoglobin (HbA1c) levels througho ut follow-up were within the normal range. Hyperinsulinemia was present thr oughout follow-up till the fourth year. The oral glucose tolerance test (OG TT) was normal in 82,5 % of the patients beyond one year after the graft. O ver time, no differences were detected on basal glucose and insulin levels and areas under the curve (AUC) of glycemia and insulinemia. During the evo lution, no differences were found in the festing insulin resistance index ( FIRI), in spite of increasing body weight. ICA were + in 2 patients before graft and + in 7 after graft (14 %). GADab were + in 10 patients before gra ft and + in 11 after graft (22 %). Conclusion: Pancreas and kidney transplantation provides without any insuli n treatment and diet long-term normalization of glycemic control, assessed by HbA1c and OGTT, despite the existence of sustained hyperinsulinemia. Our results strongly suggest that pancreas and kidney transplantation is the m ost efficient treatment for uremic patients with insulinodependent diabetes mellitus from a metabolic point of view. (C) 2001 Editions scientifiques e t medicales Elsevier SAS.