Measurement of the Pancreas Function in Patients With More Than One Pancreas After Liver and Small Bowel Transplantation

Study Overview
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Brief Summary
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Under chronic immunosuppressive and corticosteroid therapy, transplant patients have a tendency to develop in the long-term diabetes. Patients who have received extra pancreatic tissue with their liver and small bowel transplantation have not yet developed insulin resistance or diabetes mellitus. We would like to investigate to which level insulin secretory capacity the extra pancreas together with the native pancreas has in these transplant patients using the hyperglycemic clamp. These data will be compared with the data obtained from healthy controls.

Detailed Description
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The glycemic control in type 1 diabetic recipients of islet cell grafts is correlated with the ß-cell mass. In the standard technique for liver/small bowel transplant procedure previously described by Grant et al, the pancreas was removed. This surgical method was modified by Sudan et al and the donor pancreas was transplanted intact in these non-diabetic patients. Under chronic immunosuppressive and corticosteroid therapy, these patients with extra ß-cell mass have not developed insulin resistance or diabetes mellitus. To which level insulin secretory capacity the extra pancreas allograft together with the native pancreas has in these transplant patients are not yet known. Among the measures of pancreatic ß-cell-secretory capacity, the first-phase and steady state insulin secretion from the hyperglycemic clamp studies are believed to give the most robust estimates. Moreover, the hyperglycemic clamp and the euglycemic clamp yield comparable estimates of insulin sensitivity and, so that under appropriate conditions, the hyperglycemic clamp technique may be used to assess both insulin sensitivity and insulin secretion in the same individual in a single experiment.

Official Title
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Measurement of ß-cell Function and Insulin Sensitivity in Non-diabetic Patients With En-bloc Liver, Pancreas and Small Bowel Transplant Using a Hyperglycemic Clamp

Conditions
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Diabetes, Insulin Resistance, Liver/Small Bowel Transplant

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Liver/small bowel transplant patients with partial or whole pancreas Solitary small bowel transplant patients Insulin independent (no diabetes mellitus) Maintenance IS with Tacrolimus/Azathioprine
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy controls<br>10 healthy volunteers | |
| Solitary small bowel transplant patients<br>3 | |
| Liver/small bowel transplant patients<br>3 | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the stimulated serum C-peptide leveS (mean area under the curve [AUC] after hypercemic clamp test | Sampling before glucose infusion (-30 to 0 minutes) Glucose infusion (0 to 14 minutes) - increase of glycemia acutely to 180 mg/dL in approx. 14 min. Clamping at glycemia of 180 mg/dL (15 to 150 minutes) maintain glycemia at 180 mg/dL till 150 min. after start glucose infusion blood sample for measurement of glycemia, proinsulinemia and C-peptide at 120, 135 and 150 minutes (n= 3x5 ml) for evaluation of second-phase insulin release Intravenous injection of 1 mg glucagon (150 to 170 minutes) | One time | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Beta-cell function, Liver/small bowel transplant, Donor pancreas, Diabetes, Long-term immunesuppression