Performance of modified Igls criteria to evaluate islet autograft function after total pancreatectomy with islet autotransplantation – a retrospective study

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Abstract

The Igls criteria assess islet function after islet allotransplant, based on C-peptide, insulin use, hemoglobin A1c, and severe hypoglycemia. However, these criteria as currently defined cannot be applied to total pancreatectomy islet autotransplant (TPIAT) patients. We tested modified criteria for assessing islet function in a large cohort of TPIAT patients (n = 379). Metabolic outcomes were assessed. We assigned Auto-Igls class to each patient as able and evaluated the utility, validity, and perioperative risk factors of Auto-Igls at 1-year post-IAT. We tested the association of Auto-Igls with independent measures of islet graft function, specifically continuous glucose monitoring (CGM) data or acute C-peptide response to glucose (ACRglu) from intravenous glucose tolerance tests. An Auto-Igls class was assigned to 264 patients (69%). Among patients who could not be classified, most were missing exact insulin dose. Seventy-three percent of TPIAT recipients were classified as optimal or good at 1 year. The only significant predictor of Auto-Igls class was islet mass transplanted (P < 0.0001). Auto-Igls class was associated with percent time in range (70–140 mg/dl) on CGM (P = 0.02) and ACRglu (P < 0.0001). Modified Igls classification for IAT permits simple, comprehensive assessment of metabolic outcomes after TPIAT and is associated with other islet functional measures.

Original languageEnglish (US)
Pages (from-to)87-96
Number of pages10
JournalTransplant International
Volume34
Issue number1
DOIs
StatePublished - Jan 2021

Bibliographical note

Funding Information:
KRM is funded by the NIH: 1T32DK108733. MDB, JSH, and YY are funded by the NIH: R01DK109124. This research was supported by the NIH National Center for Advancing Translational Sciences (UL1TR002494). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • Igls
  • Islet transplant
  • autotransplant
  • classification
  • diabetes
  • pancreatectomy

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