Peri-transplant glycaemic control as a predictor of pancreas transplant survival

© 2020 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd..

AIMS: The relationship between peri-transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri-transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction.

METHODS: Peri-transplant glycaemic control profiles over the first 5 days postoperatively were determined by an area under the curve [AUC; average daily glucose level (mmol/L) × time (days)] and the coefficient of variation of mean daily glucose levels. Peri-transplant hyperglycaemia was defined as an AUC ≥35 mmol/day/L (daily mean blood glucose ≥7 mmol/L). Risks of graft failure associated with glycaemic control and variability and peri-transplant hyperglycaemia were determined using covariate-adjusted Cox regression.

RESULTS: We collected 7606 glucose readings over 5 days postoperatively from 123 pancreas transplant recipients. Glucose AUC was a significant predictor of graft failure during 3.6 years of follow-up (unadjusted HR [95% confidence interval] 1.17 [1.06-1.30], P = .002). Death censored non-technical graft failure occurred in eight (10%) recipients with peri-transplant normoglycaemia, and eight (25%) recipients with peri-transplant hyperglycaemia such that hyperglycaemia predicted a 3-fold higher risk of graft failure [HR (95% confidence interval): 3.0 (1.1-8.0); P = .028].

CONCLUSION: Peri-transplant hyperglycaemia is strongly associated with graft loss and could be a valuable tool guiding individualized graft monitoring and treatment. The 5-day peri-transplant glucose AUC provides a robust and responsive framework for comparing graft function.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:23

Enthalten in:

Diabetes, obesity & metabolism - 23(2021), 1 vom: 07. Jan., Seite 49-57

Sprache:

Englisch

Beteiligte Personen:

Shapey, Iestyn M [VerfasserIn]
Tan, Zheng L [VerfasserIn]
Gioco, Rossella [VerfasserIn]
Khambalia, Hussein [VerfasserIn]
Fullwood, Catherine [VerfasserIn]
Yiannoullou, Petros [VerfasserIn]
Summers, Angela [VerfasserIn]
Hanley, Neil A [VerfasserIn]
Augustine, Titus [VerfasserIn]
Rutter, Martin K [VerfasserIn]
van Dellen, David [VerfasserIn]

Links:

Volltext

Themen:

Blood Glucose
Glucose
Glycaemic control
Journal Article
Pancreas transplantation
Research Support, Non-U.S. Gov't

Anmerkungen:

Date Completed 05.07.2021

Date Revised 05.07.2021

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1111/dom.14181

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM314662022