Introduction: The lack of a validated measure of graft function after pancreas implantation has hindered our ability to monitor recipients post-transplant and identify declines in function before graft failure (return to insulin) occurs. Standard definitions of glycaemic control have been validated in diabetic and healthy control cohorts and it is unknown if equivalent criteria are applicable to pancreas transplant recipients with systemic venous drainage.

Methods: Longitudinal metabolic measures taken pre-discharge and at 3 monthly intervals post-transplant according to clinical protocol, including Hba1c, fasting and stimulated glucose and insulin were recorded for a cohort of 500 pancreas transplant recipients between 2002- 2011 with at least 4 years follow-up data. 118 graft failures were included in the cohort and compared to those with ongoing good pancreas function for patterns of functional decline. Data was censored at graft failure or last follow-up.

Results: Fasting glucose pre-discharge (HR 1.46, p=0.007) and stimulated glucose at all timepoints (HR 1.12 – 1.55, p< 0.04) were predictive of late graft failure. Insulin and c-peptide level had no association to graft failure at any time-point. HbA1c was also associated with graft failure and HbA1c >41mmol/mol at 1-year post-transplant predicted graft failure (AUC 0.842, p=0.005) with 83.3% sensitivity and 94.7% specificity in ROC analysis. Cox regression and Kaplan-Meier analysis showed 1 year HbA1c >41mmol/mol to predict graft failure (HR 37.5, p=0.001) and 5-year graft survival of 62.3% vs 98.6% for HbA1c<41mmol/mol (p<0.001).

Discussion: We have shown that 1-year HbA1c >40mmol/mol is a strong predictor of graft failure and can be used as a reliable surrogate end-point for graft failure in clinical trials. We have seen that insulin and c-peptide are not useful predictors of graft failure. However, rises in glucose or HbA1c post-transplant should serve as early warnings of risk of graft failure, and could be considered as triggers for intervention.

CITATION INFORMATION: Mittal S, Franklin R, Levy J, Gough S, Sharples E, Friend P. Assessment of the Association Between Measures of Metabolic Function and Pancreas Graft Survival. Am J Transplant. 2017;17 (suppl 3).

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