Effects of systemic delivery of insulin on plasma lipids and lipoprotein concentrations in pancreas transplant recipients

Objective: To determine whether pancreas transplantation alters lipid and lipoprotein concentrations and whether peripheral hyperinsulinemia is always associated with altered lipid levels. Design: We assessed the lipid profiles of seven pancreas-kidney recipients with insulin-dependent diabetes mellitus, seven kidney recipients without diabetes who received the same immunosuppressive agents, and eight normal subjects. Material and Methods: In the three study groups, fasting and postprandial plasma glucose, insulin, C- peptide, cholesterol, triglyceride, free fatty acid, and apolipoprotein A-I, A-II, C-II, and C-III concentrations were determined. Results: Fasting and postprandial glucose concentrations did not differ between the two transplant groups; however, peripheral insulin concentrations were twice as high (P<0.05) in the pancreas-kidney recipients as in the kidney recipients both before (102 ± 15 versus 53 ± 6 pmol/L) and after (123 ± 22 versus 61 ± 6 nmol/L per 6 hours) ingestion of a meal. Preprandial and postprandial insulin levels in both transplant groups also were greater (P<0.5) than those in normal subjects (35 ± 6 pmol/L and 40 ± 7 nmol/L per 6 hours, respectively). Despite significant differences in insulin concentrations, no differences were noted in total cholesterol, high-density or low-density lipoprotein cholesterol, plasma free fatty acids, or apolipoprotein A-I, A- II, C-II, and C-III concentrations among the study groups. Plasma triglyceride concentrations in the two transplant groups were similar (114 ± 20 versus 142 ± 18 mg/dL) and were slightly more than those in the normal subjects (80 ± 7 mg/dL). Conclusion: Despite peripheral hyperinsulinemia, pancreas transplantation can result in normal or near-normal lipid and lipoprotein concentrations. Thus, systemic delivery of insulin does not invariably produce an atherogenic lipid profile.