Pancreas and kidney transplantation: long-term endocrine function.

Area of Science:

• Nephrology
• Endocrinology
• Transplantation Immunology

Background:

• Type-1 diabetes (T1D) often leads to end-stage renal failure, necessitating combined pancreas and kidney transplantation (PKTx).
• Long-term outcomes regarding metabolic control and beta-cell function post-PKTx are crucial for patient management.

Purpose of the Study:

• To evaluate the long-term metabolic control and beta-cell function in patients with T1D after PKTx.
• To assess graft function and identify changes over a 15-year follow-up period.

Main Methods:

• A cohort of twelve patients with functioning pancreas and kidney grafts for over 15 years was studied.
• Evaluations included glycosylated hemoglobin (HbA1c), oral glucose tolerance tests (OGTT), insulinemia, and anti-GAD antibodies at multiple time points post-transplantation.

Main Results:

• HbA1c and basal glycemia remained stable, but glucose tolerance (AUC) significantly increased over 15 years (p=0.02).
• Trends showed reduced basal and AUC insulinemia, with normal OGTT in 50% of patients; four showed diabetic responses.
• Insulin resistance markers (FIRI, QUICKI) were unchanged, and anti-GAD antibodies became positive in one patient.

Conclusions:

• Pancreas transplantation demonstrates long-term functional viability and is essential for T1D patients with end-stage renal failure.
• A potential decline in oral glucose tolerance suggests gradual deterioration of pancreas graft function over time.