title: Metabolic effect of hemipancreatectomy in donors. Preoperative prediction of postoperative oral glucose tolerance.
abstract: Between November 1977 and January 1987, 55 transplantations of pancreas segments from living donors related to their recipients were performed at the University of Minnesota. A preliminary analysis of metabolic test results in donors tested 1 yr after hemipancreatectomy showed an increase in mean glucose and a decrease in mean insulin values during oral glucose tolerance tests (OGTTs) in 18 donors, a 14% increase in the mean of the mean glucose levels during 24-h metabolic profiles in 12 donors, and a decrease of 45% in the mean 24-h urinary C-peptide excretion in 21 donors. Including the studies performed postdonation, 11 of 31 (35%) donors developed an abnormal OGTT result. In a retrospective analysis, preoperative results of intravenous glucose tolerance tests (IVGTTs) and cortisone-stimulated OGTTs were found to be statistically significant predictors of an abnormal OGTT after hemipancreatectomy. The mean of the 5- to 50-min IVGTT insulin values was the best predictive test. With the cutoff value set at 62 microU/ml, this test result had a sensitivity of 100%, a specificity of 83%, and a positive predictive value of 75% for identifying donors who developed an abnormal OGTT. The sum of the 5- and 10-min IVGTT insulin (cutoff 140 microU/ml) had a sensitivity of 100%, a specificity of 67%, and a predictive value of only 60%, whereas the delta-insulin had values of 86, 71, and 60%, respectively. Both the IVGTT mean insulin and the sum of the 5-min and 10-min insulin test results were 100% predictive of an abnormal test (0% risk), but the IVGTT mean insulin excluded the lowest proportion of otherwise suitable donors (a low "false-alarm" rate). The IVGTT mean insulin can be used to identify or exclude potential donors who would develop an abnormal OGTT result should hemipancreatectomy be performed.
authors.affiliation: Department of Surgery, University of Minnesota Hospital, Minneapolis 55455.
authors.forename: D M
authors.initials: DM
authors.lastname: Kendall
authors.forename: D E
authors.initials: DE
authors.lastname: Sutherland
authors.forename: F C
authors.initials: FC
authors.lastname: Goetz
authors.forename: J S
authors.initials: JS
authors.lastname: Najarian
mesh_terms: D005951:Glucose Tolerance Test; D006801:Humans; D016381:Islets of Langerhans Transplantation; D010179:Pancreas / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care