دورية أكاديمية
Early Metabolic Measures Predict Long-term Insulin Independence in Recipients of Total Pancreatectomy and Islet Autotransplantation
| العنوان: | Early Metabolic Measures Predict Long-term Insulin Independence in Recipients of Total Pancreatectomy and Islet Autotransplantation |
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| المؤلفون: | Yoshihide Nanno, MD, PhD, James S. Hodges, PhD, Martin L. Freeman, MD, Guru Trikudanathan, MD, Sarah J. Schwarzenberg, MD, Elissa M. Downs, MD, Karthik Ramanathan, MD, Timothy L. Pruett, MD, Gregory J. Beilman, MD, Srinath Chinnakotla, MD, MCh, Bernhard J. Hering, MD, Melena D. Bellin, MD |
| المصدر: | Transplantation Direct, Vol 10, Iss 1, p e1561 (2024) |
| بيانات النشر: | Wolters Kluwer, 2024. |
| سنة النشر: | 2024 |
| المجموعة: | LCC:Surgery |
| مصطلحات موضوعية: | Surgery, RD1-811 |
| الوصف: | Background. Although diabetes after total pancreatectomy and islet autotransplantation (TP-IAT) is one of the biggest concerns for TP-IAT recipients and physicians, reliable prediction of post-TP-IAT glycemic control remains unestablished. This study was conducted to identify early predictors of insulin independence and goal glycemic control by hemoglobin A1c (HbA1c) ≤ 6.5% after TP-IAT. Methods. In this single-center, retrospective study, patients who underwent TP-IAT (n = 227) were reviewed for simple metabolic markers or surrogate indices of β-cell function obtained 3 mo after TP-IAT as part of standard clinical testing. Long-term metabolic success was defined as (1) insulin independence and (2) HbA1c ≤ 6.5% 1, 3, and 5 y after TP-IAT. Single- and multivariate modeling used 3-mo markers to predict successful outcomes. Results. Of the 227 recipients, median age 31 y, 30% male, 1 y after TP-IAT insulin independence, and HbA1c ≤ 6.5% were present in 39.6% and 72.5%, respectively. In single-predictor analyses, most of the metabolic markers successfully discriminated between those attaining and not attaining metabolic goals. Using the best model selected by random forests analysis, we accurately predicted 1-y insulin independence and goal HbA1c control in 77.3% and 86.4% of the patients, respectively. A simpler “clinically feasible” model using only transplanted islet dose and BETA-2 score allowed easier prediction at a small accuracy loss (74.1% and 82.9%, respectively). Conclusions. Metabolic testing measures performed 3 mo after TP-IAT were highly associated with later diabetes outcomes and provided a reliable prediction model, giving valuable prognostic insight early after TP-IAT and help to identify recipients who require early intervention. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2373-8731 00000000 |
| العلاقة: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001561Test; https://doaj.org/toc/2373-8731Test |
| DOI: | 10.1097/TXD.0000000000001561 |
| الوصول الحر: | https://doaj.org/article/dc6907de7c9949338aa500140d213e8aTest |
| رقم الانضمام: | edsdoj.6907de7c9949338aa500140d213e8a |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 23738731 00000000 |
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| DOI: | 10.1097/TXD.0000000000001561 |