Combined pancreas and kidney transplantation in a lean type 2 diabetic patient. Effects on insulin secretion and sensitivity.

Background/aims: Pancreas transplantation is an established method of treating Type 1 diabetes. It was our aim to test the consequences of pancreas transplantation in a Type 2 diabetic patient by determining insulin secretion and sensitivity before and after surgery. Patients and methods: A female patient with Type 2 diabetes and end-stage nephropathy was treated with combined pancreas and kidney transplantation. Before surgery and at 4 weeks, 6 months and 2 years afterwards, insulin sensitivity was measured using hyperinsulinemic euglycemic clamps and insulin secretion was quantified after oral glucose or intravenous glucagon challenges. Results: The patient was insulin resistant before surgery (glucose infusion 4.6 mg.kg -1 .min -1 , normal range 6.4±0.5 mg. kg -1 .min -1 ). Insulin sensitivity declined further after transplantation (1.4 and 3.0 mg.kg -1 min -1 after 4 weeks and 6 months, respectively), but improved to 5.4 mg.kg -1 .min -1 after 2 years. Insulin secretion was greatly impaired before surgery. Insulin and C-peptide responses after oral glucose and intravenous glucagon increased into the normal range from 6 months after surgery onwards and oral glucose tolerance remained non-diabetic (IGT). Conclusions: Insulin resistance is first aggravated after pancreas transplantation, probably due to immunosuppressive treatment including glucocorticoids, but improves on the long term. The initially impaired insulin secretion from the transplant may also be explained by the action of glucocorticoids or by transient and reversible organ damage.