Metabolic measures before surgery and long-term diabetes outcomes in recipients of total pancreatectomy and islet autotransplantation

Research output: Contribution to journalArticlepeer-review

Abstract

In this single-center, retrospective cohort study, we aimed to elucidate simple metabolic markers or surrogate indices of β-cell function that best predict long-term insulin independence and goal glycemic HbA1c control (HbA1c ≤ 6.5%) after total pancreatectomy with islet autotransplantation (TP-IAT). Patients who underwent TP-IAT (n = 371) were reviewed for metabolic measures before TP-IAT and for insulin independence and glycemic control at 1, 3, and 5 years after TP-IAT. Insulin independence and goal glycemic control were achieved in 33% and 68% at 1 year, respectively. Although the groups who were insulin independent and dependent overlap substantially on baseline measures, an individual who has abnormal glycemia (prediabetes HbA1c or fasting glucose) or estimated IEQs/kg < 2500 has a very high likelihood of remaining insulin dependent after surgery. In multivariate logistic regression modelling, metabolic measures correctly predicted insulin independence in about 70% of patients at 1, 3, and 5 years after TP-IAT. In conclusion, metabolic testing measures before surgery are highly associated with diabetes outcomes after TP-IAT at a population level and correctly predict outcomes in approximately two out of three patients. These findings may aid in prognostic counseling for chronic pancreatitis patients who are likely to eventually need TP-IAT.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
This project was supported in part by NIDDK R01‐DK109124 (PI Bellin). We gratefully acknowledge the islet isolation team members of Schulze Diabetes Institute, University Minnesota for their dedicated work; Thomas Gilmore, Jeffrey D. Ansite, Joshua J. Wilhelm, Muhamad Abudulla, David Heller, and Zachary Swanson. The authors would like to thank James Hodges for his assistance.

Publisher Copyright:
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons

Keywords

  • autotransplantation
  • clinical decision-making
  • clinical research/practice
  • islet isolation
  • islet transplantation
  • islets of Langerhans

PubMed: MeSH publication types

  • Journal Article

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