After validation of BETA-2 scores in our cohort of patients in relation to standard stimulation tests, we decided to assess the practical utility of BETA-2 in monitoring islet allograft function over time in individual patients.

We analyzed BETA-2 calculations during clinical evaluations in islet allotransplantation (ITx) recipients with up to 3 islet infusions. We specifically looked in reference to previously established BETA-2 cut-offs for the detection of glucose intolerance <18 and insulin independence >13.

574 BETA-2 scores calculated in 18 patients (10 women and 8 men) correlated well with islets function. Four patients, who experienced stable, long-term insulin independence after only one transplant, had a BETA-2 fluctuating over 18. Another 6 patients required a second or third transplant to reach the same stable outcome with the same BETA-2 characteristic. In those patients, despite only discrete changes in fasting glucose level, the BETA-2 score decreased to below 18 and continued gradually declining. This drop in BETA-2 score always predicted islet dysfunction, the need for insulin support and subsequent transplant, which became clinically obvious as BETA-2 dropped below 13. In the remaining 8 patients, even when BETA-2 eventually reached peak above 18 after subsequent transplant, islet function gradually declined without obvious reason within a year or 2. Eleven percent (28/261) of BETA-2 measurements above 18 were made early after ITx, when insulin was administered irrespectively of beta-cell function, in order to facilitate islet engraftment. In 78% of cases (309/396) when BETA-2 value was above the cut-off of 13, patients were off-insulin. The remaining 22% were on insulin due to failing islet function with dropping BETA-2 or supporting islet engraftment. BETA-2 calculations below 13 were in 92.7% (165/178) scores in patients receiving insulin. Remaining 7.3% of BETA-2 values (13/178) were below the cut-off of 13, yet patients were still off insulin due to their non-compliance to medical advice.

BETA-2 score, based on a single fasting blood sample is a very reliable tool for islet function assessment and allows early detection of islet graft decline before obvious clinical symptoms.

CITATION INFORMATION: Bachul P., Gołębiewska J., Basto L., Kijek M., Fillman N., Cieply K., Golab K., Wang L-.J., Tibudan M., Thomas C., Dębska-Ślizień A., Fung J., Witkowski P. BETA-2 Score is an Excellent Tool for Monitoring of Islet Allograft Function and Early Detection of Transplant Dysfunction Am J Transplant. 2017;17 (suppl 3).

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