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

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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.

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Fig. 1

Abbreviations

CIT:

Cold ischaemia time

IP:

Isolated pancreas transplant

SPK:

Simultaneous pancreas–kidney transplant

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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.

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Correspondence to Shruti Mittal.

Additional information

Peter J. Friend and Stephen C. L. Gough are joint senior authors.

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Mittal, S., Nagendran, M., Franklin, R.H. et al. Postoperative impaired glucose tolerance is an early predictor of pancreas graft failure. Diabetologia 57, 2076–2080 (2014). https://doi.org/10.1007/s00125-014-3320-y

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  • DOI: https://doi.org/10.1007/s00125-014-3320-y

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