The purpose of pancreas transplantation is to treat diabetes and stop the external administration of insulin. But what happens when someone gets hypoglycaemia post pancreas transplant? What does this mean? And how should it be investigated? What is your experience?
Hypoglycemia post-transplantation is not uncommon. There are a myriad of factors that may be involved including physiologic, metabolic and anatomical. The most important factor that could alter the outcome of the graft seems to be anatomic derived factors related to the perfusion of the pancreas. It would be prudent to check the arterial supply to the pancreas via an appropriate radiological examination and if a pathology is found, to make attempts to rectify it.
Hypoglisemia after pancreas tx may indicate liver is not responding properly. You should check the blood insulin level and measure liver functions. Treatment is applied accordingly.
Hypoglycemia following pancreas transplantation may be acute or chronic. Acutely, in the first few days following transplantation, this may be the result of reperfusion injury to the graft. In a particularly insulin-sensitive individual, the uncontrolled release of insulin from beta-cells injured by ischemia results in hypoglycemia. While this is rarely severe or life-threatening, it can be persistent for a few days. Spontaneous resolution is usually seen. In particular, this may occur more in grafts with systemic venous drainage, due to the absence of first-pass insulin metabolism in the liver, which is an aspect of grafts with portal venous drainage. In the long-term, hypoglycemia has been reported, and the development of nesidioblastosis of the pancreas graft has been observed. In a case report, a pancreas transplant was resected due to recipient hypoglycemia 6 years post transplant, the histology showing typical nesidioblastosis (C Semakula et al, J Clin Endocrinol Metab, 2002). Other cases are known which have been unpublished. Insulinoma should also be ruled out.
In my own experience, we had a case of persistent hypoglycemia 3 weeks post-transplant. At first, we had to rule out recipient surreptitious exogenous insulin administration (which could have psychiatric causes). Having excluded this, not without some difficulty, we were concerned about this representing an immunological response, such that normal insulin secretion was being disrupted. Allograft biopsy showed mild acute rejection. We treated the rejection, but the symptoms only mildly improved. Eventually, the symptoms resolved, but within several months, the graft, too, was lost to persistent acute rejection. We suspect the hypoglycemia may have been related, but were not able to conclusively prove this.
Agree also with Dr. Vaidya's point above. It may be seen as a result of impending graft thrombosis, as ischemic injury occurs. In this case, sugars subsequently rise rapidly. An immediate ultrasound doppler examination may help exclude this serious complication.
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