TY - JOUR
T1 - Islet size index as a predictor of outcomes in clinical islet autotransplantation
AU - Suszynski, Thomas M.
AU - Wilhelm, Joshua J.
AU - Radosevich, David M.
AU - Balamurugan, A. N.
AU - Sutherland, David E R
AU - Beilman, Gregory J.
AU - Dunn, Ty B.
AU - Chinnakotla, Srinath
AU - Pruett, Timothy L.
AU - Vickers, Selwyn M.
AU - Hering, Bernhard J.
AU - Papas, Klearchos K.
AU - Bellin, Melena D.
PY - 2014/6/27
Y1 - 2014/6/27
N2 - Background: The islet size distribution in a preparation may contribute to islet transplant outcomes. At the same islet equivalent (IE) dose, larger islets may exhibit poorer therapeutic value and this may be because of oxygen diffusion limitations that worsen in proportion to islet size. Methods: To test this hypothesis, we studied the impact of islet size index (ISI) and other islet product characteristics on outcomes after islet autotransplant (IAT) in recipients receiving a marginal islet dose (2000-4999 IEs per kg body weight) from January 1, 2009 to June 11, 2012, at the University of Minnesota (n=58). ISI was defined as the number of IE divided by the number of islet particles (IPs) in a preparation; an ISI less than 1 indicates a mean islet diameter that is less than 150 μm. The primary post-IAT outcome was 6-month insulin use status. RESULTS: Logistic regression analysis indicate that IPs/kg (P=0.001), IEs/kg (P=0.019), total IPs transplanted (P=0.040), and ISI (P=0.074) were most strongly correlated with the primary outcome. The ISI (mean±standard error) was lower for recipients achieving insulin independence at 6 months (0.71±0.05) versus those partially (0.83±0.05) or completely (1.00±0.07) insulin dependent. The combination of islet dose (expressed as units IPs/kg) and ISI exhibited a sensitivity of 75% and specificity of 74% in predicting insulin independence in this population of patients. Conclusion: Islet autotransplant recipients of a marginal islet doses were more likely to achieve insulin independence when transplanted with a greater number of smaller islets.
AB - Background: The islet size distribution in a preparation may contribute to islet transplant outcomes. At the same islet equivalent (IE) dose, larger islets may exhibit poorer therapeutic value and this may be because of oxygen diffusion limitations that worsen in proportion to islet size. Methods: To test this hypothesis, we studied the impact of islet size index (ISI) and other islet product characteristics on outcomes after islet autotransplant (IAT) in recipients receiving a marginal islet dose (2000-4999 IEs per kg body weight) from January 1, 2009 to June 11, 2012, at the University of Minnesota (n=58). ISI was defined as the number of IE divided by the number of islet particles (IPs) in a preparation; an ISI less than 1 indicates a mean islet diameter that is less than 150 μm. The primary post-IAT outcome was 6-month insulin use status. RESULTS: Logistic regression analysis indicate that IPs/kg (P=0.001), IEs/kg (P=0.019), total IPs transplanted (P=0.040), and ISI (P=0.074) were most strongly correlated with the primary outcome. The ISI (mean±standard error) was lower for recipients achieving insulin independence at 6 months (0.71±0.05) versus those partially (0.83±0.05) or completely (1.00±0.07) insulin dependent. The combination of islet dose (expressed as units IPs/kg) and ISI exhibited a sensitivity of 75% and specificity of 74% in predicting insulin independence in this population of patients. Conclusion: Islet autotransplant recipients of a marginal islet doses were more likely to achieve insulin independence when transplanted with a greater number of smaller islets.
KW - Insulin independence
KW - Islet autotransplant
KW - Islet size index
KW - Total pancreatectomy
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U2 - 10.1097/01.TP.0000441873.35383.1e
DO - 10.1097/01.TP.0000441873.35383.1e
M3 - Article
C2 - 24621532
AN - SCOPUS:84902533676
SN - 0041-1337
VL - 97
SP - 1286
EP - 1291
JO - Transplantation
JF - Transplantation
IS - 12
ER -