Utility of arginine stimulation testing in preoperative assessment of children undergoing total pancreatectomy with islet autotransplantation

Kendall R. McEachron, Mariya E. Skube, Yi Yang, James S Hodges, Joshua Wilhelm, Gregory J Beilman, Srinath Chinnakotla, Sarah J Schwarzenberg, Melena D Bellin

Research output: Contribution to journalArticlepeer-review

Abstract

Metabolic outcomes after total pancreatectomy with islet autotransplantation (TPIAT) are influenced by the islet mass transplanted. Preclinical and clinical studies indicate that insulin and C-peptide levels measured after intravenous administration of the beta cell secretagogue arginine can be used to estimate the available islet mass. We sought to determine if preoperative arginine stimulation test (AST) results predicted transplanted islet mass and metabolic outcomes in pediatric patients undergoing TPIAT. We evaluated the association of preoperative C-peptide and insulin responses to AST with islet isolation metrics using linear regression, and with postoperative insulin independence using logistic regression. Twenty-six TPIAT patients underwent preoperative AST from 2015 to 2018. The acute C-peptide response to arginine (ACRarg) was correlated with isolated islet equivalents (IEQ; r = 0.59, P = 0.002) and islet number (IPN; r = 0.48, P = 0.013). The acute insulin response to arginine (AIRarg) was not significantly correlated with IEQ (r = 0.38, P = 0.095) or IPN (r = 0.41, P = 0.071). Neither ACRarg nor AIRarg was associated with insulin use at 6 months postoperatively. Preoperative C-peptide response to arginine correlates with islet mass available for transplant in pediatric TPIAT patients. AST represents an additional tool before autotransplant to provide counseling on likely islet mass and to inform quality improvements of islet isolation techniques.

Original languageEnglish (US)
Article numbere13647
JournalClinical Transplantation
Volume33
Issue number8
DOIs
StatePublished - 2019

Bibliographical note

Funding Information:
The authors would like to acknowledge Marie Cook, APRN, CNP, for her care of pediatric TPIAT patients in the preoperative and postoperative settings. Work by KRM and MES is funded by a T32 grant in pancreatology (1T32DK108733).

Keywords

  • autotransplantation
  • clinical decision-making
  • insulin / C-peptide
  • islet isolation

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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