O20 Pancreas transplant alone in patients with type 1 diabetes mellitus. Metabolic results after 5 years of experience

Abstract

Introduction: Pancreas transplant alone (PTA) restores glycemic control with exogenous insulin independence in the after transplantation (posTx) in patients with type 1 diabetes mellitus (T1D). Between an 8% and 10% of the pancreas transplants cases are PTA. Advances in surgery techniques and immunosuppression improved the results of PTA. According to the International Registry on Organ Donation and Transplantation, survival increased to 5 years, to both the patient and the graft, 86% and 60%, respectively.

Objectives: Evaluate the metabolic PTA results in patients with T1D from the institutional Pancreatic Transplant Program.

Materials and Methods: Descriptive, observational study, in 5 T1D patients with PTA, made from 2015 to 2020; 3 were women, age 41±7 (range: 35 to 52 years old), diagnosed with T1D for 26±11 years. Pre-emptive transplant (preTx) insulin therapy, 4 with insulin infusion and 1 with MDI. PTA indication: 80% for diabetic retinopathy and metabolic lability, and 20% for psychological incapacity for insulin therapy. Donors’ age: 23.3±4.4 years, ischemic time: 10.8 hours. Pancreases were transplanted in the right iliac fossa, intraperitoneal, with anastomosis to iliac vessels. Quantitative variables with mean and standard deviation and qualitative variables with absolute frequencies are described. Correlation tendencies were calculated with Pearson’s correlation coefficient.

Results: The 5 patients with PTA were evaluated 35±18 months (range: 15 to 63 months). It was observed in preTx and posTx: C-peptide: 0.1 and 7.48±3.75 ng/mL (range 2.8 a 13 ng/mL); HbA1c: 8.7%±1% and 5.71±1%; Glycemia 244±48 and 97±9
mg/dL; amylase 53.6±22.9 UI/l and 85.7±55.6 UI/l; lipase 27±20 y 28±14 UI/l; creatinine 1.07±0.18 and 1.53±0.38 mg/dL; GF 94±48 and 68±35 mL/min/mt2; proteinuria/24hr 0.422 and 0.130 g/24hr, respectively. There was positive correlation between preTx and posTx creatinine (r 0.515), preTx creatinine and posTx amylase or lipase (r 0.753 and 0.759, respectively) and negative correlation between posTx C-peptide and posTx amylase or lipase (r -0.348 and -0.533). All of them evolved free of exogenous insulin during the posTx.

Conclusions: The 5 patients with T1D and PTA achieved immediate and prolonged insulin independence and improvement in all the metabolic indicators. Without hypoglycemias, injections or glycemic self-monitoring, they all improved their life quality. A higher preTx creatinine and posTx amylase and lipase were associated to a lower posTx kidney and pancreas function, respectively. Positive results in the first 5 PTA are motivations to continue with the institutional Pancreatic Transplant Program.