Division of Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA.
Department of Surgery, Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON.
Transplantation. 2022 Aug 1;106(8):1647-1655. doi: 10.1097/TP.0000000000004058. Epub 2022 Jul 22.
The long-term outcomes of both pancreas and islet allotransplantation have been compromised by difficulties in the detection of early graft dysfunction at a time when a clinical intervention can prevent further deterioration and preserve allograft function. The lack of standardized strategies for monitoring pancreas and islet allograft function prompted an international survey established by an International Pancreas and Islet Transplant Association/European Pancreas and Islet Transplant Association working group.
A global survey was administered to 24 pancreas and 18 islet programs using Redcap. The survey addressed protocolized and for-cause immunologic and metabolic monitoring strategies following pancreas and islet allotransplantation. All invited programs completed the survey.
The survey identified that in both pancreas and islet allograft programs, protocolized clinical monitoring practices included assessing body weight, fasting glucose/C-peptide, hemoglobin A1c, and donor-specific antibody. Protocolized monitoring in islet transplant programs relied on the addition of mixed meal tolerance test, continuous glucose monitoring, and autoantibody titers. In the setting of either suspicion for rejection or serially increasing hemoglobin A1c/fasting glucose levels postpancreas transplant, Doppler ultrasound, computed tomography, autoantibody titers, and pancreas graft biopsy were identified as adjunctive strategies to protocolized monitoring studies. No additional assays were identified in the setting of serially increasing hemoglobin A1c levels postislet transplantation.
This international survey identifies common immunologic and metabolic monitoring strategies utilized for protocol and for cause following pancreas and islet transplantation. In the absence of any formal studies to assess the efficacy of immunologic and metabolic testing to detect early allograft dysfunction, it can serve as a guidance document for developing monitoring algorithms following beta-cell replacement.
胰腺和胰岛同种异体移植的长期结果受到在临床干预可以防止进一步恶化并保留移植物功能时早期移植物功能障碍检测困难的影响。缺乏监测胰腺和胰岛同种异体移植功能的标准化策略促使国际胰腺和胰岛移植协会/欧洲胰腺和胰岛移植协会工作组建立了一项国际调查。
使用 Redcap 对 24 个胰腺和 18 个胰岛项目进行了全球调查。该调查针对胰腺和胰岛移植后的协议免疫和代谢监测策略和因病因监测策略。所有受邀项目都完成了调查。
该调查确定，在胰腺和胰岛同种异体移植项目中，协议化临床监测实践包括评估体重、空腹血糖/C 肽、糖化血红蛋白和供体特异性抗体。胰岛移植项目的协议监测依赖于混合餐耐量试验、连续血糖监测和自身抗体滴度。在怀疑排斥反应或胰腺移植后糖化血红蛋白/空腹血糖水平连续升高的情况下，多普勒超声、计算机断层扫描、自身抗体滴度和胰腺移植物活检被确定为协议监测研究的辅助策略。在胰岛移植后糖化血红蛋白水平连续升高的情况下，没有发现其他额外的检测方法。
这项国际调查确定了用于胰腺和胰岛移植后协议和因病因监测的常见免疫和代谢监测策略。在缺乏评估免疫和代谢检测以检测早期移植物功能障碍的有效性的正式研究的情况下，它可以作为开发β细胞替代后监测算法的指导文件。
