OBJECTIVE -Pancreas transplantation (PTX) normalizes glucose and improves microvascular complications, but its impact on macrovascular disease is still debated. RESEARCH DESIGN AND METHODS -Carotid intima-media thickness (IMT),shown to correlate with cardiovascular disease (CVD) risk and events, was determined prospectively by ultrasonography in successful pancreas transplant recipients to evaluate the effect of PTX on CVD risk. Carotid IMT and CVD risk factors of pancreas transplant recipients (n ϭ 25) were compared with three groups: individuals with type 1 diabetes without significant nephropathy (n ϭ 20), nondiabetic kidney transplant recipients (n ϭ 16), and normal control subjects (n ϭ 32). Mean age of pancreas transplant recipients at the time of transplantation was 42.4 Ϯ 1.2 years (mean Ϯ SE) and duration of diabetes was 25.9 Ϯ 1.4 years. RESULTS-After PTX, HbA 1c level (P Ͻ 0.0001) decreased to normal and, whereas creatinine level (P ϭ 0.0002) decreased, it remained elevated compared with normal control subjects (P Ͻ 0.05). Blood pressure, BMI, fasting lipid levels, smoking frequency, and use of hypolipidemic agents were unchanged. Mean carotid IMT was increased in pancreas transplant candidates but decreased by 1.8 Ϯ 0.1 year after PTX (P ϭ 0.0068), no longer different from that in normal control subjects or patients with type 1 diabetes.CONCLUSIONS -Carotid IMT improves after successful PTX within 2 years of the procedure, with normalization of HbA 1c and improved renal function, independent of changes in lipid levels, BMI, blood pressure, smoking, or use of hypolipidemic agents. This study suggests that CVD risk, future events, and mortality should improve after PTX in the absence of other significant, untreated CVD risk factors. Diabetes Care 27:1706 -1711, 2004C ardiovascular disease (CVD) is the most common cause of mortality in patients with diabetes. Pancreas transplantation (PTX) normalizes glucose levels far better than any other strategy available for treatment of type 1 diabetes (1). Improvement in glucose levels reduces risk of microvascular complications in type 1 and type 2 diabetes and reduces macrovascular disease events in type 2 diabetes (2,3). Whether normalization of glucose can reduce CVD in type 1 diabetes, or whether PTX can reverse CVD in type 1 diabetes after it has occurred, is not as well established. Carotid intima-media thickness (IMT) correlates with risk and future CVD events. This is the first prospective study of carotid IMT in pancreas transplant recipients to determine whether PTX changes overall CVD risk. RESEARCH DESIGN AND METHODS PTX candidatesPatients with type 1 diabetes being evaluated for PTX who agreed to participate underwent baseline carotid ultrasonography at transplant evaluation and again at least 1 year after PTX if graft function was normal. Normal graft function was defined as HbA 1c Յ6.5% (as defined by the clinical laboratory at the time of this study) and serum creatinine level Յ2.4 mg/dl. All PTX procedures were accomplished using whole-organ gra...

This is the first report of a gender difference in pancreas graft survival after SPK with greater early (<6 months) pancreas graft failure in women than men. With no gender difference in kidney graft failure in the same individuals, gender differences in immune responses are unlikely to be the cause. Multiple variables likely contribute.

The quantification of abdominal fat is a marker of health risk. While dual-energy x-ray absorptiometry (DEXA) is easily applied, it measures overall fat, although abdominal fat may be a better indicator of health risk from obesity. We have evaluated whether a subcomponent of DEXA measurements correlates better with computed tomography (CT) for body fat than those traditionally used. Forty-seven healthy adults (22 M/25 F), aged 54.5+/-15.8 yr (mean+/-SD), with BMI of 27.1+/-4.6 kg/m2 participated in a cross-sectional study. Body fat was measured using abdominal CT and DEXA for total fat, trunk fat, and a modified trunk measurement that excludes the chest, termed "lower trunk," and compared. The coefficient of variation for DEXA measurements for trunk, lower trunk, and total body were 1.98, 3.12, and 0.85%, respectively. Mean DEXA for percentage fat ranged from 31.7% to 34.1% for trunk, lower trunk, and total body, compared to 54.2% for abdominal CT (p<0.003 for each pairwise comparison). Lower trunk, whole trunk, and total body DEXA measurements were not different. Measurement of subcomponents of fat content by DEXA is not superior to whole body measurements and remains consistently lower than measurements by CT.

Women are more likely than men to have reproductive hormone abnormalities pre- and post-PTX and the causes may be multiple.

Carotid IMT is lower after PTX, suggesting a reduction in overall cardiovascular risk independent of changes in use of hypolipidemic agents, smoking, blood pressure, BMI, or lipids, except HDL. Improved carotid IMT after successful PTX predicts a reduction in future vascular disease events and suggests that the macrovascular disease of type 1 diabetes is at least partially reversible with improved glucose control.