Pendón-Ruiz de Mier V, Navarro Cabello M D, Martínez Vaquera S, Lopez-Andreu M, Aguera Morales M L, Rodriguez-Benot A, Ruiz Rabelo J, Campos Hernandez P, Requena Tapia M J, Aljama Garcia P
Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
Department of Nephrology, H.U. Reina Sofía, Córdoba, Spain.
Transplant Proc. 2015 Jan-Feb;47(1):117-9. doi: 10.1016/j.transproceed.2014.11.024.
Pancreas-kidney transplantation (PKT) is the best therapeutic option for diabetic patients with end-stage renal failure. Peripheral insulin resistance and the percentage of remaining β-cells in the PKT have been little studied in medical literature.
We analyzed PKT performed in our hospital from January 1992 to January 2014, with follow-up for 5 years. Metabolic values related to glycemic were studied, namely, proteinuria, peptide C, glucose, insulin, and glycosylated hemoglobin. We analyzed insulin resistance (homeostatic model assessment [HOMA]-IR), the percentage of remaining β-cells (HOMA-β), and the influence of these variables on the glycemic profile and graft survival.
In the study period, 156 simultaneous PKT were performed in our center. At 2 years posttransplantation, the median value of HOMA-IR kidney-pancreas was 4. We compared transplantation with lower HOMA-IR (<4) and higher HOMA-IR (>4). HOMA-β (36 [26-67] vs 29 [14-42]; P = .04), glucose (86 [80-90] vs 81 [74-89]; P = .018), and body mass index (BMI; 24 [21-27] vs 21 [19-24]; P = .013) were greater in the group HOMA-IR>4 versus HOMA-IR<4 group, respectively, after 3 months. These differences in glycemic profile were maintained until the first year after transplantation. At 2 and 5 years of follow-up, the HOMA-IR>4 group showed higher glucose levels and greater BMI, but not differences in HOMA-β. At 1 and 5 years posttransplantation, pancreatic graft survival in the HOMA-IR>4 group (82.9% vs 92.5%) was lower compared with the HOMA-IR<4 group (67% vs 87.5%; P = .016).
PKT exhibit an altered glycemic profile in the posttransplantation follow-up associated with the percentage of remaining β-cells and peripheral insulin resistance. PKT patients with peripheral insulin resistance showed decreased pancreatic graft survival.
胰肾联合移植（PKT）是终末期肾衰竭糖尿病患者的最佳治疗选择。医学文献中对外周胰岛素抵抗和PKT中剩余β细胞百分比的研究较少。
我们分析了1992年1月至2014年1月在我院进行的PKT，并进行了5年的随访。研究了与血糖相关的代谢值，即蛋白尿、C肽、葡萄糖、胰岛素和糖化血红蛋白。我们分析了胰岛素抵抗（稳态模型评估[HOMA]-IR）、剩余β细胞百分比（HOMA-β）以及这些变量对血糖谱和移植物存活的影响。
在研究期间，我们中心共进行了156例同期PKT。移植后2年，肾胰联合移植的HOMA-IR中位数为4。我们比较了HOMA-IR较低（<4）和较高（>4）的移植情况。3个月后，HOMA-IR>4组的HOMA-β（36[26-67]对29[14-42]；P = 0.04）、葡萄糖（86[80-90]对81[74-89]；P = 0.018）和体重指数（BMI；24[21-27]对21[19-24]；P = 0.013）分别高于HOMA-IR<4组。这些血糖谱差异一直维持到移植后第一年。在随访的2年和5年时，HOMA-IR>4组的血糖水平和BMI更高，但HOMA-β无差异。移植后1年和5年，HOMA-IR>4组的胰腺移植物存活率（82.9%对92.5%）低于HOMA-IR<4组（67%对87.5%；P = 0.016）。
PKT在移植后随访中呈现出与剩余β细胞百分比和外周胰岛素抵抗相关的血糖谱改变。外周胰岛素抵抗的PKT患者胰腺移植物存活率降低。
