To date, the definition of pancreas transplant (PTX) failure is based on the need for antidiabetic therapy. However, as even a marginal PTX function can improve blood glucose control, a more differentiated defintion is needed. As the proposed defintions are complicated, the applicability is to be questioned.

To better characterize PTX insufficiency, we analyzed the HbA1c and C-peptide values from 107 SPK patients and classified the patients based on HbA1c, antidiabetic therapy and C-peptid levels. The patients were assessed based on the lab testing at study entry (median 8.9 years after SPK) and followed up once a year.According to the tests used in our laboratory we used a HbA1c ≥6,0% as cut off for impaired glucose homeostasis.

Four groups of patients were identified:

Normal graft function: Patients without antidiabetic therapy with normal HbA1c ( n = 71 )

Impaired graft function: Patients without therapy with elevated HbA1c and detectable C-Peptide ( n = 7 )

Clinically manifest graft insufficiency: Patients with therapy, variable HbA1c but detectable C- peptide (n = 14)

Terminal allograft failure: Patients with therapy, variable HbA1c but negative C – peptide (n = 16)

While Group 1 essentially consists of normoglycemic patients and Group 4 essentially consists of patients with complete loss of their PTX function, it becomes evident from Groups 2 and 3 that "anti-diabetic therapy " or [bdquo]elevated HbA1c“ as sole criterion is not sufficient to characterize the whole scope of PTX failure. .

At baseline blood glucose and HbA1c levels were significant higher in group 2-4 compared with group one. Similar results were found at one and two years after study entry. Renal transplant function was similar in all patient groups.

Our data show that a clinically relevant and easily applicable definition of PTX function can be made based on HbA1c, antidiabetic therapy and C-peptide secretion in PTX- patients. Important markers of glucose metabolism differbetween the respective groups.

This definition of PTX function could be the base for further studies on patient outcome and differentiated therapy.

CITATION INFORMATION: Kahl A, Hinrichs C. Simplified Classification of Pancreas Transplant Insufficiency. Am J Transplant. 2017;17 (suppl 3).

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