title: Use of glucose disappearance rates (kG) to monitor endocrine function of pancreas allografts.
abstract: We have reported that a decline in glucose disappearance rate (kG) in pancreas transplant recipients is associated with pancreatic rejection. The purpose of this study was to determine test-retest reliability of kG monitoring and to establish the kG criteria for diagnosing abnormal graft function. Six healthy non-diabetic volunteers and 14 stable pancreas recipients underwent 2 intravenous glucose tolerance tests 7 d apart. All kG values in non-diabetic volunteers had < 15% variation between the two determinations (r = 0.96, P < or = 0.0006). Similarly, 13/14 recipients experienced < 20% variation in kG with one patients experiencing a 23% variation (r = 0.90, P < or = 0.0001). Using a 20% change from baseline as the reference value, we monitored 28 pancreas recipients for 2-36 months post-transplant. Of 253 kG values, 160 (64%) did not exceed the 20% change from baseline, 65 (26%) declined > 20% and 28 (11%) increased > 20%. Of 160 stable kG values, 154 (96%) were associated with normal graft function while 6 (4%) occurred in the context of rejection. Of 65 kG values declining by > or = 20%, 47 (72%) accurately identified acute rejections diagnosed by biopsy (70%) or response to treatment (30%), 12 (19%) were associated with identifiable causes of increased insulin resistance and only in 6 (9%) cases a cause for the decline was unidentifiable. The kG values with > 20% rise from baseline were, in 15%, associated with identifiable causes of decreased insulin resistance. The sensitivity of the kG as a marker for rejection was 88.7%, specificity 91%, positive predictive value 72.3%, negative predictive value 96.8%, and accuracy 90.5%. These data confirm that a > 20% deterioration of glucose disappearance rate is associated with pancreas allograft rejection, and confirms the utility of kG monitoring in clinical follow-up of pancreas transplant recipients.
authors.affiliation: Department of Surgery, The University of Tennessee, Memphis 38163, USA. AGaber@UTMEM1.UTMEM.Edu
authors.forename: D S
authors.initials: DS
authors.lastname: Elmer
authors.forename: D K
authors.initials: DK
authors.lastname: Hathaway
authors.forename: A
authors.initials: A
authors.lastname: Bashar Abdulkarim
authors.forename: T A
authors.initials: TA
authors.lastname: Hughes
authors.forename: H
authors.initials: H
authors.lastname: Shokouh-Amiri
authors.forename: L W
authors.initials: LW
authors.lastname: Gaber
authors.forename: A O
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D005260:Female; D005951:Glucose Tolerance Test; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000502:physiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014184:Transplantation, Homologous
chemical_list: D001786:Blood Glucose