Advertisement

Diabetologia

, Volume 57, Issue 10, pp 2076–2080 | Cite as

Postoperative impaired glucose tolerance is an early predictor of pancreas graft failure

  • Shruti MittalEmail author
  • Myura Nagendran
  • Rachel H. Franklin
  • Edward J. Sharples
  • Peter J. Friend
  • Stephen C. L. Gough
Article

Abstract

Aims/hypothesis

The management of pancreatic transplantation is limited by a lack of clinically relevant early markers of graft dysfunction to enable intervention prior to irreversible damage. The aim of this study was to assess the OGTT as an early predictor of pancreatic graft failure.

Methods

Patients with graft failure (return to insulin dependence) were identified from a prospectively maintained clinical database. Data from OGTTs performed within 2 weeks of the transplant were retrospectively collected for 210 subjects, 42 with graft failure (21 after simultaneous pancreas–kidney transplant and 21 after isolated pancreas transplant) matched to 168 with functioning grafts. The groups were compared to assess the relationship between early OGTT result and pancreas graft failure.

Results

Mean 2 h glucose from the OGTT was significantly higher in the overall graft failure group compared with the control group (8.36 vs 6.81 mmol/l, p = 0.014). When interpreted in combination with fasting glucose, abnormal glucose tolerance was more common in the failed graft group (50% vs 22%, p = 0.001). In an adjusted model, abnormal glucose tolerance emerged as the most predictive independent factor for graft failure, HR 1.66 (95% CI 1.22, 2.24), p = 0.001. These findings were consistent between the different transplant procedures performed.

Conclusions/interpretation

We conclude that early post-transplant abnormal glucose tolerance is associated with later whole organ pancreas graft failure. An OGTT performed within the first month postoperatively provides an easily measurable assessment of an independent early risk factor of pancreatic graft dysfunction.

Keywords

Metabolic biomarkers Pancreas transplant Risk factors Survival Transplant outcome Type 1 diabetes 

Abbreviations

CIT

Cold ischaemia time

IP

Isolated pancreas transplant

SPK

Simultaneous pancreas–kidney transplant

Notes

Acknowledgements

We would like to acknowledge our consultant colleagues at the Oxford Transplant Centre, R. Ploeg, A. Vaidya, S. Sinha, I. Quiroga, J. Gilbert and S. Reddy, who have contributed to the generation of this data.

Funding

The first author was funded through a Clinical Research Fellowship from the NIHR Biomedical Research Centre, Oxford.

Duality of interest

The authors of this manuscript have no conflicts of interest.

Contribution statement

All authors contributed to the concept and design of the study, acquisition of data, analysis and interpretation. All authors were involved in the preparation of the article draft and final version. SM is responsible for the integrity of the work as a whole.

References

  1. 1.
    Gruessner RW, Gruessner AC (2013) The current state of pancreas transplantation. Nat Rev Endocrinol 9:555–562PubMedCrossRefGoogle Scholar
  2. 2.
    Axelrod DA, Sung RS, Meyer KH, Wolfe RA, Kaufman DB (2010) Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant 10:837–845Google Scholar
  3. 3.
    Dieterle CD, Veitenhansl M, Gutt B et al (2007) Impaired glucose tolerance in pancreas grafted diabetic patients is due to insulin secretory defects. Exp Clin Endocrinol Diabetes 115:647–653PubMedCrossRefGoogle Scholar
  4. 4.
    Gruessner AC, Sutherland DE, Gruessner RW (2012) Long-term outcome after pancreas transplantation. Curr Opin Organ Transplant 17:100–105PubMedCrossRefGoogle Scholar
  5. 5.
    Pfeffer F, Nauck MA, Drognitz O, Benz S, von Dobschuetz E, Hopt UT (2003) Postoperative oral glucose tolerance and stimulated insulin secretion: a predictor of endocrine graft function more than 10 years after pancreas-kidney transplantation. Transplantation 76:1427–1431PubMedCrossRefGoogle Scholar
  6. 6.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553PubMedCrossRefGoogle Scholar
  7. 7.
    Battezzati A, Benedini S, Caldara R et al (2001) Prediction of the long-term metabolic success of the pancreatic graft function. Transplantation 71:1560–1565PubMedCrossRefGoogle Scholar
  8. 8.
    Baitello M, Galante NZ, Coutinho Lde S et al (2011) Impact of delayed pancreatic graft function in simultaneous pancreas-kidney transplantation. J Bras Nefrol 33:180–188PubMedCrossRefGoogle Scholar
  9. 9.
    Sosenko JM, Skyler JS, Herold KC, Palmer JP (2012) The metabolic progression to type 1 diabetes as indicated by serial oral glucose tolerance testing in the Diabetes Prevention Trial-Type 1. Diabetes 61:1331–1337PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Shruti Mittal
    • 1
    • 2
    • 3
    Email author
  • Myura Nagendran
    • 4
  • Rachel H. Franklin
    • 1
  • Edward J. Sharples
    • 5
    • 6
  • Peter J. Friend
    • 1
    • 6
  • Stephen C. L. Gough
    • 3
    • 5
  1. 1.Oxford Transplant CentreChurchill HospitalOxfordUK
  2. 2.Nuffield Department of SurgeryUniversity of OxfordOxfordUK
  3. 3.NIHR Oxford Biomedical Research CentreOxfordUK
  4. 4.Green Templeton CollegeUniversity of OxfordOxfordUK
  5. 5.Oxford Centre for Diabetes, Endocrinology and MetabolismOxfordUK
  6. 6.Nuffield Department of MedicineUniversity of OxfordOxfordUK

Personalised recommendations