*Purpose: DCD pancreas transplantation has become common with equivalent graft survival as that of DBD grafts, but are the metabolic outcomes similar? Given the lack of marker of graft function, can HbA1C (glycosylated hemoglobin A1C) predict long-term graft function? We aimed to address these questions.

*Methods: Single center retrospective analysis of 160 pancreas transplants performed from 2006 to 2019 was done. After excluding graft loss within 6 weeks (n=20) and missing data (n=17) the remaining 123 grafts (DBD=105/ DCD=18) were included. Functioning graft is defined as remaining insulin independent. IFCC (International Federation of Clinical Chemistry) HbA1C under 42mmol/mol is defined as normal. Secondary complication is defined as any of the following events post-transplant: myocardial infarction, cerebrovascular accident, minor or major amputations, death. Rejection is either antibody mediated with de novo DSA (Donor specific antibody) or T-cell mediated or mixed and biopsy proven.

*Results: There was a statistically significant difference in median HbA1C at 1 year between functioning DBD and DCD grafts (DBD=34.50, n=92/ DCD= 38.50, n=16/ p=0.03, Mann Whitney test) but this difference was not found at 3 months (DBD=33, n=104/ DCD=33.50, n=18/ p=0.87). The median percentage weight gain was significantly higher in the DCD cohort (DBD=5.74% vs DCD=15.67%, p=0.006, Mann Whitney test). The percentage of type 2 diabetes was statistically insignificant between the two groups (DBD=14.29% vs DCD=11.11%, p>0.99). The incidence of rejection (DBD=34.29% vs DCD= 27.78%, p=0.78), steroid free rate (DBD=63.81% vs DCD=72.22%, p=0.59) and incidence of secondary complication in functioning grafts (DBD=21.69% vs DCD=18.75%, p>0.99) were not significantly different between DBD and DCD cohort. Among the grafts functioning at 1 year, the death censored median graft survival was significantly longer (p=0.0004, log rank test) for those with normal HbA1C at 1 year (142 months, n=90) compared to those with abnormal HbA1C at 1 year (99 months, n=8).

*Conclusions: In contrast to the existing literature we noted a higher median HbA1C at 1 year and a higher median percentage weight gain in the DCD cohort. The implication of this is a potential question for further studies. It is evident that HbA1C can serve as a predictor of long-term graft function. The role metabolic evaluation with mixed meal tolerance test and beta cell scan in functioning grafts with abnormal HbA1C is another avenue to be explored.

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