*Purpose: Transplant recipients are susceptible to metabolic syndrome as typified by hyperglycemia, central obesity and increased insulin resistance after transplant, which may precede the onset of post-transplant diabetes. Here we assess one surrogate of metabolic syndrome, weight gain in diabetic recipients after pancreas transplantation.

*Methods: This is a single center study of 32 simultaneous pancreas and kidney (SPK) and 5 pancreas after kidney (PAK) transplant recipients from 2014-2018. Starting c-peptide levels < 0.2 ng/mL were used to denote insulin deficiency (n = 25) or levels > 0.2 ng/mL as insulin resistant (n = 12). Hemoglobin A1c (HgbA1c), BMI and weight were assessed.

*Results: There was no difference in recipient or donor age between the insulin deficient and insulin resistant groups (38 vs. 40, p=0.41; 22 vs. 24, p=0.27). Duration of diabetes was longer in the insulin deficient group (28 vs. 19 years; p=0.01). HgbA1c at time of transplant was higher in the insulin deficient group (8.6 vs 7.3%; p=0.02). At one year HgbA1c was 5.9% in the insulin deficient recipients and 5.6% in the insulin resistant group (p = 0.56). Average BMI after transplant was higher in the insulin resistant group 28.6 v. 24.4 kg/m² (p = 0.03) despite no difference in starting BMIs (24.9 v. 24.0 kg/m² (p = 0.42). The insulin resistant group also had a larger percent weight change from their starting weight 13.1% v. 0.9 % at 1-year (p = 0.02). Mean follow up time was 780 days. In the insulin deficient group there was one graft loss and one patient death.

Linear regression demonstrated that starting c-peptide was a significant predictor of change in post-transplant percent weight gain (p=0.01) and change in BMI (p=0.01) at one year.

*Conclusions: Patients with elevated c-peptides at time of transplant are susceptible to rapid weight gain after transplant. These patients may benefit from aggressive nutritional management.

« Back to 2019 American Transplant Congress