Abstract
Insulin is routinely used to manage hyperglycaemia in organ donors and during the peri-transplant period in islet transplant recipients. However, it is unknown whether donor insulin use (DIU) predicts beta-cell dysfunction after islet transplantation. We reviewed data from the UK Transplant Registry and the UK Islet Transplant Consortium; all first-time transplants during 2008-2016 were included. Linear regression models determined associations between DIU, median and coefficient of variation (CV) peri-transplant glucose levels and 3-month islet graft function. In 91 islet cell transplant recipients, DIU was associated with lower islet function assessed by BETA-2 scores (β [SE] -3.5 [1.5], P = .02), higher 3-month post-transplant HbA1c levels (5.4 [2.6] mmol/mol, P = .04) and lower fasting C-peptide levels (-107.9 [46.1] pmol/l, P = .02). Glucose at 10 512 time points was recorded during the first 5 days peri-transplant: the median (IQR) daily glucose level was 7.9 (7.0-8.9) mmol/L and glucose CV was 28% (21%-35%). Neither median glucose levels nor glucose CV predicted outcomes post-transplantation. Data on DIU predicts beta-cell dysfunction 3 months after islet transplantation and could help improve donor selection and transplant outcomes.
Highlights
In patients with type 1 diabetes mellitus (T1DM), islet cell transplantation (ICT) provides an opportunity to alleviate life-threatening hypoglycaemia, improve glycaemic control, reduce the progression of diabetes related microvascular complications, and in some cases, achieve insulin independence.[1,2] the routine attainment of insulin independence after islet transplantation from a single donor is unusual thereby prompting efforts to better understand donor selection and to improve post-transplant islet graft function.Several factors, including higher donor glucose levels, are known to predict poorer outcomes after islet isolation[3,4]
These relationships remained significant after adjusting for age, BMI and total number of islets transplanted (IEQ/kg) (Table 2) Rates of graft failure were higher in transplants from Donor Insulin Use (DIU) compared with no-DIU this was not statistically significant (5/45 vs 1/41, p=0.22)
Main findings We have shown that DIU is associated with poorer graft function in ICT recipients
Summary
In patients with type 1 diabetes mellitus (T1DM), islet cell transplantation (ICT) provides an opportunity to alleviate life-threatening hypoglycaemia, improve glycaemic control, reduce the progression of diabetes related microvascular complications, and in some cases, achieve insulin independence.[1,2] the routine attainment of insulin independence after islet transplantation from a single donor is unusual thereby prompting efforts to better understand donor selection and to improve post-transplant islet graft function.Several factors, including higher donor glucose levels, are known to predict poorer outcomes after islet isolation[3,4]. In patients with type 1 diabetes mellitus (T1DM), islet cell transplantation (ICT) provides an opportunity to alleviate life-threatening hypoglycaemia, improve glycaemic control, reduce the progression of diabetes related microvascular complications, and in some cases, achieve insulin independence.[1,2] the routine attainment of insulin independence after islet transplantation from a single donor is unusual thereby prompting efforts to better understand donor selection and to improve post-transplant islet graft function. The relationship between donor insulin use (DIU) and outcomes post-transplantation has not been investigated. The co-administration of insulin and heparin during the peri-transplant period has been associated with higher rates of insulin independence post-transplantation[5]. There is limited observational data to suggest that tighter glycaemic control is associated with better beta cell function post-transplant
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