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Donor insulin use predicts beta-cell function after islet transplantation |
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| Authors: | Iestyn M Shapey PhD Angela Summers PhD Petros Yiannoullou MBBS Hussein Khambalia PhD Catherine Fullwood PhD Neil A Hanley PhD John Casey PhD Shareen Forbes PhD Miranda Rosenthal PhD Paul RV Johnson MD Pratik Choudhary PhD James Bushnell MD James A M Shaw PhD Titus Augustine MS Martin K Rutter MD David van Dellen MD |
| Institution: | 1. Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK;2. Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;3. Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK Department of Research and Innovation (medical statistics), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;4. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK;5. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK Endocrinology Unit, University of Edinburgh, Edinburgh, UK;6. Diabetes Unit, Royal Free Hospital, London, UK;7. Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK;8. Diabetes Research Group, King's College London, London, UK;9. Richard Bright Renal Unit, Southmead Hospital, Bristol, UK;10. Institute of Cellular Medicine, Newcastle University, Newcastle, UK;11. Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;12. Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK Department of Research and Innovation (medical statistics), Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK |
| Abstract: | Insulin is routinely used to manage hyperglycaemia in organ donors and during the peri-transplant period in islet transplant recipients. However, it is unknown whether donor insulin use (DIU) predicts beta-cell dysfunction after islet transplantation. We reviewed data from the UK Transplant Registry and the UK Islet Transplant Consortium; all first-time transplants during 2008-2016 were included. Linear regression models determined associations between DIU, median and coefficient of variation (CV) peri-transplant glucose levels and 3-month islet graft function. In 91 islet cell transplant recipients, DIU was associated with lower islet function assessed by BETA-2 scores (β SE] -3.5 1.5], P = .02), higher 3-month post-transplant HbA1c levels (5.4 2.6] mmol/mol, P = .04) and lower fasting C-peptide levels (?107.9 46.1] pmol/l, P = .02). Glucose at 10 512 time points was recorded during the first 5 days peri-transplant: the median (IQR) daily glucose level was 7.9 (7.0-8.9) mmol/L and glucose CV was 28% (21%-35%). Neither median glucose levels nor glucose CV predicted outcomes post-transplantation. Data on DIU predicts beta-cell dysfunction 3 months after islet transplantation and could help improve donor selection and transplant outcomes. |
| Keywords: | insulin islet organ donor pancreas transplant |