Department of Renal and Pancreas Transplantation, Manchester University NHSFT, Manchester, UK.
Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
Diabetes Obes Metab. 2021 Jan;23(1):49-57. doi: 10.1111/dom.14181. Epub 2020 Oct 5.
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.
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.
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].
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.
围手术期血糖控制与胰腺移植后结局之间的关系尚不清楚。我们旨在研究围手术期血糖控制与胰腺移植物存活率的关系，并制定定义早期移植物功能障碍的框架。
通过曲线下面积（AUC；平均每日血糖水平（mmol/L）×时间（天））和平均每日血糖水平的变异系数来确定术后前 5 天的围手术期血糖控制曲线。围手术期高血糖定义为 AUC≥35mmol/天/L（每日平均血糖≥7mmol/L）。使用协变量调整的 Cox 回归确定与血糖控制和变异性以及围手术期高血糖相关的移植物失功风险。
我们从 123 例胰腺移植受者中收集了术后 5 天内的 7606 个血糖读数。血糖 AUC 是 3.6 年随访期间移植物失功的显著预测因子（未经调整的 HR [95%置信区间] 1.17 [1.06-1.30]，P=.002）。在围手术期血糖正常的 8 名（10%）受者和围手术期高血糖的 8 名（25%）受者中发生了死亡相关的非技术移植物失功，因此高血糖预测移植物失功的风险增加了 3 倍[HR（95%置信区间）：3.0（1.1-8.0）；P=.028]。
围手术期高血糖与移植物丢失密切相关，可能是指导个体化移植物监测和治疗的有价值工具。5 天围手术期血糖 AUC 为比较移植物功能提供了一个强大且敏感的框架。
