Pancreas transplantation in C-peptide positive patients: does "type" of diabetes really matter?

Autor:	Stratta RJ; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC. Electronic address: rstratta@wakehealth.edu., Rogers J; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC., Farney AC; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC., Orlando G; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC., El-Hennawy H; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC., Gautreaux MD; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC., Reeves-Daniel A; Department of Internal Medicine (Section of Nephrology), Wake Forest School of Medicine, Winston-Salem, NC., Palanisamy A; Department of Internal Medicine (Section of Nephrology), Wake Forest School of Medicine, Winston-Salem, NC., Iskandar SS; Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC., Bodner JK; Department of General Surgery (Section of Transplantation), Wake Forest School of Medicine, Winston-Salem, NC.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2015 Apr; Vol. 220 (4), pp. 716-27. Date of Electronic Publication: 2014 Dec 20.
DOI:	10.1016/j.jamcollsurg.2014.12.020
Abstrakt:	Background: In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). Study Design: We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL. Results: From November 2001 to March 2013, we performed 162 SPKTs including 30 (18.5%) in patients with C-peptide levels ≥ 2.0 ng/mL pretransplantation (C-peptide positive group, range 2.1 to 12.4 ng/mL) and 132 in patients with absent or low C-peptide levels (<2.0 ng/mL, C-peptide "negative"). C-peptide positive patients were older at SPKT, had a later age of onset and shorter duration of pretransplantation DM, and more were African-American (all p < 0.05) compared with C-peptide negative patients. With a mean follow-up of 5.6 years, patient (80% vs 82.6%), kidney graft (63.3% vs 68.9%), and pancreas graft survivals (50% vs 62.1%, all p = NS) rates were comparable in C-peptide positive and negative patients, respectively. At latest follow-up, there were no differences in acute rejection episodes, surgical complications, major infections, readmissions, hemoglobin A1c levels, serum creatinine, and estimated glomerular filtration rate levels between the 2 groups. C-peptide levels were higher (mean 5.0 vs 2.6 ng/mL, p < 0.05) and post-transplant weight gain (≥ 5 kg) was more common (57% vs 33%, p = 0.004) in the C-peptide positive group. Survival outcomes in C-peptide positive (n = 14) vs C-peptide negative (n = 22) African-American patients were similar, as were outcomes in C-peptide positive patients with a body mass index < or ≥ 28 kg/m(2). Conclusions: Patients with higher pretransplantion C-peptide levels appear to have a type 2 DM phenotype compared to insulinopenic patients undergoing SPKT. However, survival and functional outcomes were similar, suggesting that pretransplantation C-peptide levels should not be used exclusively to determine candidacy for SPKT. (Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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