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Peri‐transplant glycaemic control as a predictor of pancreas transplant survival
Author(s) -
Shapey Iestyn M.,
Tan Zheng L.,
Gioco Rossella,
Khambalia Hussein,
Fullwood Catherine,
Yiannoullou Petros,
Summers Angela,
Hanley Neil A.,
Augustine Titus,
Rutter Martin K.,
Dellen David
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14181
Subject(s) - medicine , confidence interval , perioperative , transplantation , area under the curve , diabetes mellitus , pancreas transplantation , proportional hazards model , surgery , gastroenterology , urology , endocrinology , kidney transplantation
Aims The relationship between peri‐transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri‐transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction. Methods Peri‐transplant glycaemic control profiles over the first 5 days postoperatively were determined by an area under the curve [AUC; average daily glucose level (mmol/L) × time (days)] and the coefficient of variation of mean daily glucose levels. Peri‐transplant hyperglycaemia was defined as an AUC ≥35 mmol/day/L (daily mean blood glucose ≥7 mmol/L). Risks of graft failure associated with glycaemic control and variability and peri‐transplant hyperglycaemia were determined using covariate‐adjusted Cox regression. Results We collected 7606 glucose readings over 5 days postoperatively from 123 pancreas transplant recipients. Glucose AUC was a significant predictor of graft failure during 3.6 years of follow‐up (unadjusted HR [95% confidence interval] 1.17 [1.06‐1.30], P = .002). Death censored non‐technical graft failure occurred in eight (10%) recipients with peri‐transplant normoglycaemia, and eight (25%) recipients with peri‐transplant hyperglycaemia such that hyperglycaemia predicted a 3‐fold higher risk of graft failure [HR (95% confidence interval): 3.0 (1.1‐8.0); P = .028]. Conclusion Peri‐transplant hyperglycaemia is strongly associated with graft loss and could be a valuable tool guiding individualized graft monitoring and treatment. The 5‐day peri‐transplant glucose AUC provides a robust and responsive framework for comparing graft function.