Long-term follow-up of lipid metabolism and rheologic properties after successful pancreas and kidney transplantation

Blood rheological properties are strongly related to the metabolic syndrome in middle-aged Chinese

The current investigation sought to evaluate the relation between hemorheological properties and the metabolic syndrome. 1400 office workers aged 35 to 59 years were enrolled in this study. Waist circumference and blood pressure were determined. Plasma high-density lipoprotein (HDL cholesterol), triglyceride, fasting blood glucose, plasma insulin and whole blood viscosity (WBV) at a high-shear rate of 200 s(-1) were measured at the attendance. Metabolic syndrome was defined according to National Cholesterol Education Program (NCEP)/ATP III guidelines. The metabolic syndrome was identified in 18% of this sedentary population. Mean WBV was 4.71+/-0.56 mPa s. One-way ANOVA indicated WBV increased across subjects with 0-4 metabolic syndrome components (F=3.86, p<0.01). The highest vs. lowest quartiles of WBV occurred significantly more often among subjects as the number of metabolic syndrome components increased. Across five categories of the metabolic syndrome, the frequencies of the occurrence of the highest vs. lowest quartiles were: 0.40, 0.87, 1.31, 1.92, and 4.80, respectively, showing a significant correlation (R=0.817, p<0.05). Univariate logistic regression analysis showed that the prevalence of hyperviscosity was predicted positively by waist circumference (OR=1.018, 95% CI: 1.002-1.035, p<0.05) and negatively by HDL cholesterol (OR=0.295, 95% CI: 0.133-0.680, p<0.01), independently of age, sex, and smoking status. In summary, this study has shown that WBV is strongly related to the severity of the metabolic syndrome. We suggest that the hemorheological parameters could potentially be used as an additional indicator of the metabolic syndrome.

Pancreas transplantation

Although intensified insulin therapy regimens enable normalization of blood glucose levels and related metabolic parameters, these regimens are associated with an increased incidence of hypoglycemic episodes. Pancreas transplantation has achieved the goal of providing insulin independence with stable and continuous normoglycemia. But because of the associated morbidity and mortality and the need for life-long immunosuppression after transplant, it is difficult to justify pancreas transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation is therefore performed in conjugation with renal transplantation. The majority of renal transplant centers, however, have been reluctant to perform simultaneous kidney-pancreas transplantation in insulin-dependent uremic patients because of the additional risks associated with pancreas transplantation. More recently, refinements in surgical technique, introduction of new immunosuppressive agents, and better selection of transplant candidates have contributed to improved survival. Today, combined pancreas-kidney transplantation is an accepted treatment for carefully selected patients with insulin dependent diabetes and end-stage renal disease and in a small group of patients with uncontrolled severe metabolic problems. The effect of a euglycemic state after pancreas transplantation on the progression of micro- and macroangiopathy remains to be proved, although recently there is evidence to suggest that some end-organ lesions may be halted or even ameliorated. Further improvement in anti-rejection strategies may achieve better long-term graft survival and provide the incentive to perform pancreas transplantation at an earlier stage, before severe secondary complications of diabetes develop.