Ann Surg Treat Res.  2021 Sep;101(3):187-196. 10.4174/astr.2021.101.3.187.

Beneficial effects of posttransplant dipeptidyl peptidase-4 inhibitor administration after pancreas transplantation to improve β cell function

• Jang HW
• Jung CH
• Ko Y
• Lim SJ
• Kwon HE
• Jung JH
• Kwon H
• Kim YH
• Shin S

• KMID: 2519849
• DOI: http://doi.org/10.4174/astr.2021.101.3.187

Abstract

Purpose
Dipeptidyl peptidase-4 (DPP-4) inhibitors lower blood glucose levels and enhance the function of pancreatic βcells. Yet, it is unknown whether posttransplant administration of DPP4 inhibitors is beneficial for pancreas transplant recipients.
Methods
We thus retrospectively analyzed the records of 312 patients who underwent pancreas transplantation between 2000 and 2018 at Asan Medical Center (Seoul, Korea) and compared the metabolic and survival outcomes according to DPP-4 inhibitor treatment.
Results
The patients were divided into the no DPP-4 inhibitor group (n = 165; no treatment with DPP-4 inhibitors or treated for <1 month) and the DPP-4 inhibitor group (n = 147; treated with DPP-4 inhibitors for ≥1 month). There were no significant differences in levels of glucose, hemoglobin A1c, and insulin between the 2 groups during 36 months of follow-up. However, the level of C-peptide was significantly higher in the DPP-4 inhibitor group at 1, 6, and 24 months posttransplant (all P < 0.05). Moreover, the DPP-4 inhibitor group had significantly higher rates of overall (log-rank test, P = 0.009) and death-censored (log-rank test, P = 0.036) graft survival during a 15-year follow-up.
Conclusion
Posttransplant DPP-4 inhibitor administration may help improve the clinical outcomes including β cell function after pancreas transplantation.

Keyword

Beta cell function; Dipeptidyl peptidase-4 inhibitor; Insulin sensitivity; Pancreas transplantation

Figure

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  Fig. 1 Patient selection flow. DPP-4, dipeptidyl peptidase 4.

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  Fig. 2 Comparison of metabolic variables including glucose (A), C-peptide (B), fasting insulin (C), and hemoglobin A1c (HbA1c) (D) between the dipeptidyl peptidase 4 (DPP-4) inhibitor group and the no DPP-4 inhibitor group in the unadjusted linear mixed model. *P < 0.05.

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  Fig. 3 Comparison of metabolic variables including glucose (A), C-peptide (B), fasting insulin (C), and hemoglobin A1c (HbA1c) (D) between the dipeptidyl peptidase 4 (DPP-4) inhibitor group and the no DPP-4 inhibitor group in the adjusted linear mixed model. *P < 0.05.

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  Fig. 4 Comparison of metabolic variables including HOMA β cell and HOMA-IR between the dipeptidyl peptidase 4 (DPP-4) inhibitor group and the no DPP-4 inhibitor group in the unadjusted (A and B) and adjusted (C and D) linear mixed models. HOMA-IR, homeostasis model assessment (HOMA) of insulin resistance; HOMA β cell, HOMA β cell function.

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  Fig. 5 Kaplan-Meier curves for 15-year survival (A), overall graft survival (B), and death-censored graft survival (C) according to posttransplant use of dipeptidyl peptidase 4 (DPP-4) inhibitor.

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