Examination of Carbohydrate Metabolism Parameters After Simultaneous Pancreas-Kidney Transplantation K. Földes, L. Piros, É. Toronyi, L. Wagner, R. Chmel, Sz. Török, K. Nagy, Á. Ghimessy, D. Brinzanek, B. P} ocze, R.M. Langer, and L. Ger } o ABSTRACT End-stage renal failure, a frequent complication of type 1 diabetes mellitus, requires renal replacement therapy. Our team examined the laboratory parameters of carbohydrate metabolism in 18 patients with type 1 diabetes at 10 to 89 months after simultaneous pancreas-kidney transplantation. We compared these results with those of 17 patients with type 1 diabetes who had formerly received kidney-alone transplantations, and were undergoing insulin treatment, as well as with those of 16 metabolically healthy controls. The hemoglobin A1c (HbA1c) and blood glucose levels of the pancreas-kidney transplant recipients were within the normal ranges, not differing significantly from those of the healthy controls. In contrast, the HbA1c and glucose levels were significantly elevated among kidney transplanted diabetic subjects. However, fasting and 2-hour insulin levels of pancreas-kidney transplant patients were significantly higher than those of the controls, indicating insulin resistance. According to these results, the insulin secretion by the pancreas graft sufficiently compensated for insulin resistance. Thus 10 to 89 months after successful pancreas-kidney transplantation, carbohydrate metabolism by type 1 diabetic patients was well controlled without antidiabetic therapy. T YPE 1 DIABETES (T1D) evolves due to a false autoimmune response that results in irreversible and progressive destruction of insulin-producing beta cells of the pancreas. The death of beta cells leads to total and defini- tive elimination of endogenous insulin production. Possible treatments are exogenous insulin administration, or in a few cases, the implantation of beta cells. Implantation can be a surgical procedure of the entire pancreatic organ or isolated beta cell-containing islet infusion. According to recent ex- periences, long-term success is secured by pancreas trans- plantation surgery. The first pancreas transplantation was performed by Kelly and Lillehei in 1966 in Minneapolis, Minnesota, United States. Although the recipient died from septic complica- tions in a month, the postoperative decrease of the patient’s blood sugar level had proved pancreas transplantation to be a choice of therapy for type 1 diabetics. 1 During the next 12 years, 98 pancreas transplantations were carried out, but the results were less positive than expected, and only 1 pa- tient survived 1 year after surgery. Most recipients died in a few months because of complications such as thrombosis, infection, sepsis, abscess, or fistula. In the 1980s, a series of changes occurred that led to improved pancreas transplantation outcomes. New and effective immunosuppressive drugs as well as broad-spectrum antibiotics and the perfection of surgical procedures led to better pancreas graft survival rates and extended patient survival too. The number of pancreas transplantations suddenly increased, and in the 1990s it had reached 1000 per year globally. Two thirds of the surgeries were per- formed in the United States and only one third in all other countries. During pancreas transplantation, the most frequently used technique worldwide is at present enteric exocrine drainage and systemic venous drainage, which causes the pancreas to produce insulin driven into systemic From the Department of Transplantation and Surgery (K.F., L.P., É.T., L.W., R.C., S.T., K.N., A.G., D.B., B.P., R.M.L.) and 1st Department of Internal Medicine (L.G.), Semmelweis University, Budapest, Hungary. Address reprint requests to: Robert Langer, Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. 0041-1345/13/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.10.006 ª 2013 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 3698 Transplantation Proceedings, 45, 3698e3702 (2013)