Lipid Status After Pancreas-Kidney Transplantation

Abstract

Objective –This study was performed to determine the net effects of euglycemia, resolution of renal failure, immunosuppressant drugs, and hyperinsulinemia on fasting lipid profiles of patients with renal failure and insulin-dependent diabetes mellitus (IDDM) after combined pancreas-kidney transplantation (PKT). Research Design and Methods –Thirty subjects with IDDM received PKT between April 1989 and October 1990, and all were studied. Mean ± SE age was 35.2 ± 1.3 yr; 19 recipients were men, and 11 were women. All had a functioning pancreatic allograft post-PKT. Fasting lipid profiles including total cholesterol (C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-chol), and C/HDL-chol were compared before and after PKT (38–555 days divided into groups: preoperation and 0–2, 3–8, and 9–19 mo). Results –Significant hyperlipidemia was observed preoperatively (means ± SE): C, 5.92 ± 0.27 mM; HDL-chol, 1.07 ± 0.09 mM; TG, 5.85 ± 0.56 mM; and C/HDL-chol, 6.49 ± 0.83. All lipids and C/HDL-chol dropped immediately after PKT (0-2 mo vs. preoperation, all P < 0.01, except HDL-chol). After this immediate postoperative period, C, HDL-chol, and TG stabilized at new concentrations. C (5.44 ± 0.22 mM) and TG (4.54 ± 0.48 mM) levels were < preoperation (not statistically significant and P < 0.05, respectively). HDL-chol was greater than preoperative values (1.29 ± 0.06 mM, P < 0.05). C/HDL-chol dropped after PKT (0-2 mo, 4.85 ± 0.18, P < 0.01) and continued to decrease throughout the observation period (3-8 mo, 4.42 ± 0.23; 9-19 mo, 4.23 ± 0.23; both P < 0.01 vs. preoperation). There was no statistical difference between lipid concentrations in male and female subjects. Conclusions –The lipid status of subjects with IDDM and renal failure was abnormal before PKT and once lipid concentrations stabilized after PKT (> 2 mo), HDL-chol was higher and TG and C/HDL-chol levels were significantly lower than preoperative values. If these changes are sustained, risk of future cardiovascular disease in this group of patients might be significantly reduced.