Background: The indications and outcomes of pancreas transplantation for type 2 diabetes mellitus (T2DM) remains controversial. The aim of this study was to compare the long-term effects of pancreas transplantation in the context of metabolic control and β-cell function between type 1 diabetes mellitus (T1DM) and T2DM patients in a Western Population.

Methods: The glycemic profiles of 145 consecutive patients with T1DM (N=131) and T2DM (N=14) who received a pancreas transplant in our institution between 2010 and 2015 were compared. Endocrine function was evaluated at 6, 12, and 24 months after the pancreas transplantation. After 8-hours fasting, the fasting blood glucose (FBG), HbA1c, and c-peptide were measured. Endocrine function was also assessed after oral glucose tolerance with 75 g of glucose. Postprandial C‐peptide‐to‐glucose ratio (PCGR) and fasting C‐peptide‐to‐glucose ratio (FCGR) were also calculated. Impaired glucose tolerance (IGT) was based on WHO criteria.

Results: Throughout the follow-up period, postoperative HbA1c did not differ significantly between T1DM and T2DM patients. While no difference in PCGR was recorded at each time point, FCGR was significantly higher in the T2DM group at 6 months (P=0.048), 12 months (P=0.001), and 24 months (P=0.005). OGTT revealed a higher prevalence of IGT in T2DM patients that increased over time with a significant difference at 24 months (83% of T2DM versus 29% of T1DM, P =0.006). All T2DM patients with abnormal OGTTs at 6 months demonstrated no improvement or worsening of glycemic control at 24 months. Additionally, while both patient groups experienced an upward trend in BMI post-transplant, T2DM patients saw a more dramatic increase at 6 months (7.5% T2DM versus 0.04% T1DM P=0.019), 12 months (9.8% versus 2.0% P=0.017), and 24 months (10.8% versus 2.7% P=0.048). The median C-peptide stimulation ratio (2 hours:0 hours post glucose challenge) at 6, 12, and 24 months was comparable between the two groups.

Conclusions: OGTT reveals a high rate of IGT following pancreas transplantation for T2DM patients. There was no significant difference in β-cell function after pancreas transplantation between T1DM and T2DM patients. Further studies are necessary to define which interventions can mitigate the decline of glycemic control in each patient population.

CITATION INFORMATION: Doshi S., Pulitano C., Al-Adra D., Norgate A., Sapisochin G., Selzner M., McGilvray I., Schiff J., Cattral M. Pancreas Transplant for Type 2 Diabetes is Associated with Preserved Function, but Impaired Glucose Tolerance: A Comparative Analysis Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress