Effect of Pancreas Transplantation on Lipoprotein Lipase, Postprandial Lipemia, and HDL Cholesterol

Föger, Bernhard; Königsrainer, Alfred; Pálos, G; Brandstätter, E; Ritsch, Andreas; König, Paul; Miesenböck, G; Lechleitner, Monika; Margreiter, Raimund; Patsch, Josef R.

doi:10.1097/00007890-199410270-00007

Cited by 38 publications

(14 citation statements)

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“…The ultimate goal of pancreas transplantation as a treatment option for type I diabetes is freedom from exogenous insulin administration with improvement or disappearance of diabetic secondary complications and improved quality of life (18)(19)(20)(21)(22)(23). That pancreas transplantation has achieved widespread acceptance as a safe and effective treatment for type I diabetes is reflected in the much improved results reported over the last several years, which has been facilitated in our center by the use ofTAC as a primary therapy for immunosuppression without antilymphocyte induction therapy (3,5,24).…”

Section: Discussionmentioning

confidence: 99%

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

et al. 2000

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Purpose-The results of steroid withdrawal in pancreas transplant recipients under tacrolimus immunosuppression were analyzed. July 4, 1994 until April 30, 1998, 147 pancreas transplantations were performed in 141 patients, including 126 simultaneous pancreas-kidney transplantations, 13 pancreas after kidney transplantation, and 8 pancreas transplantations alone. Baseline immunosuppression consisted of tacrolimus and steroids without antilymphocyte induction. Twenty-three patients were excluded from analysis because of early graft loss in 17 cases, retransplantation in 5 cases, and simultaneous pancreas-kidney transplantation after heart transplantation in 1 patient. Methods-FromResults-With a mean follow-up of 2.8±1.1 years (range 1.0 to 4.8 years), complete steroid withdrawal was achieved in 58 (47%) patients with a mean time to steroid withdrawal of 15.2±8 months (range 4 to 40 months after transplantation). Of the entire cohort of 141 patients, overall 1-, 2-, and 4-year patient survival rates were 98%, 95.5%, and 86%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 83%, 80%, and 71% (pancreas) and 95%, 91%, and 84% (kidney), respectively. Of the 124 patients analyzed for steroid withdrawal, 1-, 2-, and 4-year patient survival rates were 98%, 97%, and 92%, respectively. Overall 1-, 2-, and 4-year graft survival rates were 98%, 91.5%, 83% (pancreas) and 97%, 95%, and 91% (kidney). Patient, pancreas, and kidney survival rates at 1 year were 100%, 100%, and 98% (off steroids) versus 97%, 91%, and 96% (on steroids, all NS) and at 4 years were 100%, 94%, and 95% (off steroids) versus 78%, 68%, and 85% (on steroids, P=0.01, 0.002, and NS, respectively). The cumulative risk of rejection at the time of follow-up was 76% for patients on steroids versus 74% for patients off steroids (P=NS). Seven patients originally tapered off steroids were treated for subsequent rejection episodes, which were all steroid sensitive, and two of these seven patients are currently off steroids. Thirteen patients received antilymphocyte therapy for steroid-resistant rejection, five of whom are now off steroids. Tacrolimus trough levels were 9.3±2.4 ng/ml (off steroids) and 9.7±4.3 (on steroids, P=NS). Mean fasting glucose levels were 98±34 mg/dl (off steroids) and 110±41 mg/dl (on steroids, P=NS). Mean glycosylated hemoglobin levels were 5.2±0.9% (off steroids) and 6.2±2.1% (on steroids, P=0.02), and mean serum creatinine levels were 1.4±0.8 mg/dl (off steroids) and 1.7±1.0 mg/dl (on steroids, P=0.02). Conclusion-These data show for the first time that steroid withdrawal can be safely accomplished in pancreas transplant recipients maintained on tacrolimus-based immunosuppression. Steroid withdrawal is associated with excellent patient and graft survival with no increase in the cumulative risk of rejection.The results of pancreas transplantation have improved dramatically over the last decade with 1-year patient survival rates greater than 90%, and pancreas graft survival rates in simultaneous pancreas-kidney tra...

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Section: Discussionmentioning

confidence: 99%

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

et al. 2000

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“…Data are means (SEM). From Foger et al [5] terol was clearly increased in PKT-R compared with NKT-R and controls, mainly due to an elevation of the HDL, subfraction as determined by a precipitation procedure (Table 1). Notably, only HDL, cholesterol discriminated between the study groups and showed a much more pronounced relative increase in PKT-R and DKT-R than HDL, cholesterol (Table 1).…”

Section: Resultsmentioning

confidence: 84%

“…1) [5]. To explain the increased triglyceride tolerance of PKT-R, we examined the activity of LPL, the rate-limiting enzyme in the catabolism of triglyceriderich lipoproteins (TGRLP) ( Table 2) [5, 61.…”

Section: Resultsmentioning

confidence: 99%

“…a PKT-R vs NKT-R, p < 0.05; PKT-R vs CO, p < 0.01; PKT-R vs CO, p < 0.05; NKT-R vs CO, p < 0.05. Adapted from (5,6) tein, HDL [5, 61. Our cross-sectional observations are corroborated by the study of Katz et al [lo] who found increased fasting triglycerides in NKT-R when compared with healthy controls, but normal fasting triglycerides in PKT-R.…”

Section: Discussionmentioning

confidence: 99%

“…a PKT-R vs NKT-R, p < 0.005; NKT-R vs DKT-R, p < 0.005; NRT-R vs CO, p < 0.05; PKT-R vs CO, p < 0.05; g PKT-R vs CO, p < 0.005; DKT-R vs CO, p < 0.05. Adapted from (5) NKT-R vs CO, p < 0.005; PKT-R vs NRT-R, p < 0.05; lin resistance but purely iatrogenic because of the systemic insulin drainage of the pancreas graft [3]. To address the question of whether hyperinsulinemia in PKT-R also leads to a pro-atherogenic lipoprotein phenotype, we determined the levels and composition of plasma lipoproteins, triglyceride clearance capacity, and lipoprotein-modifying enzymes in PKT-R and compared them both with those of nondiabetic kidney transplant recipients (NKT-R) to control for immunosuppression and with those of healthy controls [S, 61.…”

Section: Introductionmentioning

confidence: 99%

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Pancreas transplantation modulates reverse cholesterol transport

et al. 1999

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Hyperinsulinemia secondary to insulin resistance in type-I1 diabetes or in the metabolic syndrome is associated with the "atherogenetic lipoprotein phenotype": high triglycerides, small, dense lowdensity lipoprotein (LDL) cholesterol, and low high-density lipoprotein (HDL) cholesterol. In contrast, hyperinsulinemia in pancreas-kidney transplant recipients (PKT-R), secondary to systemic venous drainage of the heteropically implanted pancreas graft, leads to high lipoprotein lipase (LPL) activity and a presumably antiatherogenic lipoprotein profile with very attenuated postprandial lipemia, high HDL cholesterol, and a preponderance of large-sized HDL (HDLJ and large buoyant LDL particles. We interpret these findings to suggest that in PKT-R, peripheral hyperinsulinemia upregulates LPL activity in peripheral tissues, which induces rapid clearance of chylomicron triglycerides from plasma and, thus, attenuates postprandial lipemia. Low postprandial lipemia allows little net cholesteryl ester transfer from HDL to triglyceride-rich lipoproteins, keeping the levels of the antiatherogenic lipoprotein HDL high and potentially increasing, thereby reverse cholesterol transport. The type of lipoprotein metabolism and pattern present in PKT-R is associated with a low cardiovascular risk in the general population; it cannot be excluded, however, that hyperinsulinemia as found in PKT-R may contribute to atherosclerosis by effects unrelated to lipoprotein metabolism.

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Improved patient survival in recipients of simultaneous pancreas–kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease

Mohan

Safi

Little

et al. 2003

British Journal of Surgery

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Effect of Pancreas Transplantation on Lipoprotein Lipase, Postprandial Lipemia, and HDL Cholesterol

Cited by 38 publications

References 0 publications

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

Results of Pancreas Transplantation After Steroid Withdrawal Under Tacrolimus Immunosuppression 1

Pancreas transplantation modulates reverse cholesterol transport

Improved patient survival in recipients of simultaneous pancreas–kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease

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