Background

Total Pancreatectomy with Islet Auto-transplantation (TPIAT) has been actively performed on patients with severe, debilitating pain of chronic pancreatitis or recurrent acute pancreatitis. It is shown that islet dose of >5000IEQ/kg has a higher likelihood to become insulin independent, but the outcome is affected by several variables such as peri-transplant inflammation, poor revascularization etc. Patient selection for TPIAT is of major concern, and it is necessary to predetermine metabolic outcomes to select the patients that will benefit the most from this procedure. Our group has previously reported the use of SUITO index as a measure of beta cell function. In this study, [Delta]C-peptide and [Delta]SUITO index has been devised to predict outcome of transplantation.

Methods

A total of 17 patients underwent TPIAT at Virginia Commonwealth University. The beta cell function was evaluated prior to surgery by measuring, Hba1C, blood glucose and c-peptide. The SUITO index at both basal and stimulated conditions was calculated using the formula:

SUITO= 1500 X C-peptide_{(basal/stimulated)} level [ng/dL]/(Blood Glucose_{(basal/stimulated)} level [mg/dL] – 63)

[Delta]C-peptide is the difference between the basal and stimulated c-peptide and the [Delta]SUITO index is the difference between basal and stimulated SUITO indices. A Pearson correlation analysis of [Delta]c-peptide and [Delta]SUITO index with final IEQ, Hba1C, C-peptide, insulin dose and glucose level at 3month and 6month post-transplantation was performed.

Results

A strong negative correlation between pre-transplant [Delta]C-peptide with the Hba1C and Glucose level at 6month post transplantation was identified. Furthermore, a positive correlation between [Delta]C-peptide and SUITO index 6 month post-transplantation was also observed. More interestingly, higher [Delta]SUITO index was associated with increased islet yield in those patients. Increase in [Delta]SUITO index was associated with decreased Hba1C and glucose level and increased C-peptide and SUITO index at 6 month Post-transplantation.

Conclusion

Our data suggests that pre-transplant [Delta]C-peptide and [Delta]SUITO index can be used to determine the post-transplant metabolic outcome of the patient.

CITATION INFORMATION: Kanak M., Shindo Y., Levy M. Early Predictors of Metabolic Outcomes in TPIAT Am J Transplant. 2017;17 (suppl 3).

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