This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Frystyk, J. Articles by Nauck, M. A. Search for Related Content PubMed PubMed Citation Articles by Frystyk, J. Articles by Nauck, M. A. Related Collections Diabetes and Insulin Metabolism

Comparison of Pancreas-Transplanted Type 1 Diabetic Patients with Portal-Venous Versus Systemic-Venous Graft Drainage: Impact on Glucose Regulatory Hormones and the Growth Hormone/Insulin–Like Growth Factor-I Axis

Medical Research Laboratories (J.F.), Clinical Institute and Medical Department M, Aarhus University Hospital, DK-8000 Aarhus, Denmark; Departments of Medicine (R.A.R., J.M., W.S., M.A.N.) and Surgery (M.B., R.L., J.K.), Ruhr-University, Knappschafts-Krankenhaus, 44780 Bochum, Germany; Department of Internal Medicine I (R.A.R.), University of Heidelberg, 69120 Heidelberg, Germany; Department of Visceral and Transplant Surgery (R.L., J.K.), Medizinische Hochschule Hannover, 30625 Hannover, Germany; and Diabeteszentrum Bad Lauterberg (M.A.N.), 37431 Bad Lauterberg im Harz, Germany

Address all correspondence and requests for reprints to: Dr. Jan Frystyk, Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark. E-mail: jan{at}frystyk.dk.

Context: Pancreas grafts can be drained through the iliac vein (systemic drainage) or the portal vein.

Objective: We hypothesized that normalization of portal insulin in patients with portal pancreas graft drainage stimulates the GH/IGF-I axis and thereby contributes to glucose control.

Methods: We compared patients after combined kidney and pancreas transplantation with portal drainage (n = 7) to patients with systemic drainage of the pancreas graft (n = 8) and nondiabetic controls (n = 8). Overnight fasting sera were analyzed for free and total IGF-I and IGF-binding proteins. Glucose regulatory hormones were examined after an oral glucose tolerance test and GH after stimulation with GHRH.

Results: Systemic drainage led to higher basal and stimulated insulin levels than portal drainage (P < 0.05), but increments in response to oral glucose were reduced in both transplanted groups (P < 0.05 vs. controls). However, glucose tolerance was similar in all groups. Circulating free and total IGF-I and IGF-binding protein-3 were similar to control levels in the systemic drainage group but elevated in the portal drainage group (P < 0.05). Consistently, the GH response was reduced in the portal drainage group (P < 0.05 vs. controls) and correlated inversely with free IGF-I (r = –0.63, P < 0.05).

Conclusion: Portal drainage of pancreatic endocrine secretion in pancreas graft recipients raises IGF-I and lowers GH secretion. These changes might explain that glucose regulation is maintained despite lower peripheral insulin levels, compared with patients with systemic graft drainage and nondiabetic control subjects.