EFFECT OF COMBINED KIDNEY-PANCREAS TRANSPLANT ON THE LIPID PROFILE: ONE YEAR FOLLOW-UP

Abstract

367 Patients with type 1 diabetes mellitus are known to be at high risk for cardiac and peripheral vascular events. Lipoprotein abnormalities are considered largely responsible for this elevated risk. We sought to assess the impact of kidney-pancreas (K-P) transplantation on the lipid abnormalities among a selected group of patients followed for at least one year. We obtained total cholesterol, HDL, LDL and triglyceride levels of 70 patients (56% male) prior to K-P transplant and again one year later. At one year, total apoA-I, apoA-II and apoB levels and serum Lp(a) levels were assessed. ApoE phenotype was also obtained in 55% of patients. Patients achieved good glycemic control; the mean hemoglobinA1c one year post-transplant was 5.4±0.9%. The mean creatinine at one year was 1.62±0.6 mg/dl. There was a statistically significant decrease in triglyceride levels and increase in HDL levels. There was no significant change in the total cholesterol and LDL levels, although there was a trend towards a decline in both.Table At one year, mean levels of apoA-I were 144.2± 24.9 mg/dl, apoA-II 47.3±10.7 mg/dl and apoB 100.5±22.3 mg/dl. The mean Lp(a) level was 14.8±16.4 mg/dl. Except for the mean Lp(a) level, which is somewhat lower, these are comparable to previously reported levels for diabetic transplant recipients. The predominant apoE phenotype was E3/3 (58.7%). E3/2 was found among 20%, E4/3 among 18.7% and E4/2 among 2.6% of patients. The results of our study demonstrate that diabetic patients show improved lipid profiles one year following K-P transplant, possibly related to the restoration of normal kidney function and glycemic control. This may partly explain the perceived improvement in vascular outcomes that has been noted among these patients; the increased use in recent years of anti-lipemic medications and anti-proliferative antihypertensive agents may also contribute. Our patients had a somewhat higher prevalence of the apoE 4 allele than has been previously noted. This is a risk factor for ischemic events among uremic patients; its contribution to an excess risk of vascular events among transplant patients has not been defined.