NO IMPROVEMENT OF PANCREAS TRANSPLANT ENDOCRINE FUNCTION BY EXOGENOUS INSULIN INFUSION (ISLET REST) IN THE POSTOPERATIVE PERIOD

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Abstract
The concept of islet exhaustion maintains that exposure of pancreatic islets to hyperglycemia and other stresses leads to islet dysfunction and irreparable damage. The process of pancreatic transplantation places many stresses on islets (e.g., counter-regulatory hormones, steroids, cyclosporine toxicity). As practiced by some centers, it may be important to administer exogenous insulin in the postoperative period to provide islet rest. Using a porcine pancreas transplant model that simulates clinical transplantation, we studied 2 groups: 1 group (n=8) received constant insulin infusion for 7 days after transplantation; the control group (n=5) received vehicle only. The islets in the insulin infusion group were rested as evidenced by a significantly decreased mean C-peptide level (0.27 .+-. 0.04 ng/ml) as compared to the control group (0.66 .+-. 0.08 ng/ml) (P < 0.05). After insulin infusion was discontinued, intravenous glucose tolerance testing found insulin, C-peptide and glucagon responses were not different between groups. Glucose clearance was also comparable; K values were -1.79 and -1.60 in the insulin infusion and control groups, respectively. In conclusion, islet rest by insulin infusion for 7 postoperative days did not improve subsequent pancreas transplant endocrine function.