title: Postoperative impaired glucose tolerance is an early predictor of pancreas graft failure.
abstract: OBJECTIVE
  The management of pancreatic transplantation is limited by a lack of clinically relevant early markers of graft dysfunction to enable intervention prior to irreversible damage. The aim of this study was to assess the OGTT as an early predictor of pancreatic graft failure.
  
  
  METHODS
  Patients with graft failure (return to insulin dependence) were identified from a prospectively maintained clinical database. Data from OGTTs performed within 2 weeks of the transplant were retrospectively collected for 210 subjects, 42 with graft failure (21 after simultaneous pancreas-kidney transplant and 21 after isolated pancreas transplant) matched to 168 with functioning grafts. The groups were compared to assess the relationship between early OGTT result and pancreas graft failure.
  
  
  RESULTS
  Mean 2 h glucose from the OGTT was significantly higher in the overall graft failure group compared with the control group (8.36 vs 6.81 mmol/l, p = 0.014). When interpreted in combination with fasting glucose, abnormal glucose tolerance was more common in the failed graft group (50% vs 22%, p = 0.001). In an adjusted model, abnormal glucose tolerance emerged as the most predictive independent factor for graft failure, HR 1.66 (95% CI 1.22, 2.24), p = 0.001. These findings were consistent between the different transplant procedures performed.
  
  
  CONCLUSIONS
  We conclude that early post-transplant abnormal glucose tolerance is associated with later whole organ pancreas graft failure. An OGTT performed within the first month postoperatively provides an easily measurable assessment of an independent early risk factor of pancreatic graft dysfunction.
authors.affiliation: Oxford Transplant Centre, Churchill Hospital, Old Street, Headington, Oxford, OX3 7LE, UK, shruti.mittal@gtc.ox.ac.uk.
authors.forename: Shruti
authors.initials: S
authors.lastname: Mittal
authors.forename: Myura
authors.initials: M
authors.lastname: Nagendran
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Franklin
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Sharples
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
authors.forename: Stephen C L
authors.initials: SC
authors.lastname: Gough
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery; D005260:Female; D018149:Glucose Intolerance / Q000150:complications*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D016035:Pancreas Transplantation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose