Peri-Transplant Glycaemic Control as a Predictor of Pancreas Transplant Survival
1Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, United Kingdom
2Department of Renal and Pancreatic Transplantaion, Manchester University NHS Foundation Trust, Manchester, United Kingdom.
Meeting: 2018 American Transplant Congress
Abstract number: A338
Keywords: Insulin, Pancreas, Pancreas transplantation
Session Information
Session Name: Poster Session A: Pancreas and Islet: All Topics
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction: The impact of peri-transplant glycaemic control on outcomes after pancreas transplantation is unknown. Our aims were to relate peri-transplant glycaemic control to survival and improve our understanding of peri-transplant dysglycaemia by describing its relationship with inflammation.
Methods: Peri-transplant glycaemic control profiles over the first 5 days postoperatively were determined by the area under the curve (AUC) of daily means and the coefficient of variation (CV). Serial blood samples were obtained at multiple time points over the first 3 days post-operatively to measure levels of circulating inflammatory mediators (TNFα, IL6, IL10, and CRP). Covariate adjusted Cox regression determined whether AUC and CV predicted graft survival and linear regression assessed relationships between inflammatory mediators and glucose levels. Survival models were adjusted for donor variables: insulin requirement; donors after circulatory death status and body mass index.
Results: Between 2010 and 2015, we collected 7606 glucose readings from 125 pancreas transplant recipients, and inflammatory mediator data in a subgroup (n=45). Median (IQR) for glucose AUC: 32 (30-35) mmol.day/L and glucose CV: 96 (81-111) %. During a median follow-up of 3.6 years, graft failure occurred in 36 (29%) recipients. Technical graft failures within 5 days were excluded (n=12). Glucose AUC predicted graft loss (adjusted HR (95%CI): 1.16 (1.05-1.28) p=0.004). Glucose CV also predicted graft loss (adjusted HR (95%CI): 0.96 (0.93-0.99) p=0.002). No significant relationships between inflammatory mediators (TNFα, IL6, IL10, and CRP) and glucose levels nor survival were identified.
Conclusion: Peri-transplant hyperglycaemia and/or variability could be a cause of graft loss through glucotoxicity or it could be a consequence of early graft dysfunction – predicting later graft loss. Intervention studies could assess whether better glycaemic control in pancreas transplant recipients can improve graft survival.
CITATION INFORMATION: Shapey M., Tan R., Khambalia H., Fullwood C., Yianoullou P., Summers A., Augustine T., Rutter M., van Dellen D. Peri-Transplant Glycaemic Control as a Predictor of Pancreas Transplant Survival Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Shapey M, Tan R, Khambalia H, Fullwood C, Yianoullou P, Summers A, Augustine T, Rutter M, Dellen Dvan. Peri-Transplant Glycaemic Control as a Predictor of Pancreas Transplant Survival [abstract]. https://atcmeetingabstracts.com/abstract/peri-transplant-glycaemic-control-as-a-predictor-of-pancreas-transplant-survival/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress