Abstract

We explored glucometabolic and renal function after engraftment in all 159 consecutive patients with type 1 diabetes who received pancreas transplantation alone (PTA, n = 80) or simultaneous pancreas and kidney transplantation (SPK, n = 79) in Norway from 2012 until 2017. We report fasting levels of plasma glucose (FPG), C-peptide, eGFR and the homeostasis model assessment of insulin sensitivity (HOMA2(%S)) and beta-cell function (HOMA2(%B)) measured one to three times weekly during the first 8 and at 52 weeks after transplantation. One year after engraftment, in the PTA and SPK groups 52 and 64 were normoglycaemic without exogenous insulin, and two and zero patients were dead. Data at the 52-week visit were missing for 5 and 6 patients in the respective groups. During the first 8 weeks, FPG was lower, C-peptide and HOMA2(%S) were higher and eGFR was lower in the SPK group as compared with the PTA group (all p < .05). 30 out of 157 living patients needed insulin treatment 52 weeks after transplantation, 9/79 in the SPK group and 21/78 in the PTA group (p = .02). In conclusion, patients who underwent SPK showed lower insulin sensitivity, but higher insulin secretory capacity and lower mean blood glucose levels the first 8 weeks after transplantation. Also, a higher proportion of patients in the SPK group were insulin-free after 1 year, compared with the PTA group.

摘要

我们在所有 159 名连续接受单独胰腺移植（PTA，n  = 80）或同时接受胰肾移植（SPK，n = 79) 在挪威从 2012 年到 2017 年。我们报告空腹血糖 (FPG)、C 肽、eGFR 水平以及胰岛素敏感性 (HOMA2(%S)) 和 β 细胞功能 (HOMA2(%) 的稳态模型评估B)) 在移植后的前 8 周和第 52 周每周测量 1 到 3 次。植入一年后，在 PTA 和 SPK 组中，52 和 64 人血糖正常，没有外源性胰岛素，有 2 人和 0 人死亡。各组中 5 名和 6 名患者在 52 周就诊时的数据缺失。在最初的 8 周内，与 PTA 组相比，SPK 组的 FPG 较低，C 肽和 HOMA2(%S) 较高，eGFR 较低（所有p < .05)。移植后 52 周，157 名存活患者中有 30 名需要胰岛素治疗，SPK 组为 9/79，PTA 组为 21/78（p  = .02）。总之，接受 SPK 的患者在移植后的前 8 周表现出较低的胰岛素敏感性，但较高的胰岛素分泌能力和较低的平均血糖水平。此外，与 PTA 组相比，SPK 组 1 年后无胰岛素的患者比例更高。