Donor insulin therapy in intensive care predicts early outcomes after pancreas transplantation

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Angela Summers
  • Hussein Khambalia
  • Petros Yiannoullou
  • Catherine Fullwood
  • David Van Dellen

Abstract

Introduction: Approximately 50% of organ donors develop hyperglycaemia on intensive care, which is managed with insulin therapy. We aimed to determine the relationships between donor insulin use (DIU) and graft failure in pancreas transplantation. Methods: United Kingdom (UK) Transplant Registry organ donor data were linked with national data from the UK solid pancreas transplant programme. All pancreas transplants performed between 2004 and 2016 with complete follow-up data were included. Logistic regression models determined associations between DIU and causes of graft failure within 3 months. Area under Receiver Operating Characteristic (ROC) curves and Net Reclassification Improvement (NRI) assessed the added value of DIU as a predictor of graft failure. Results: In 2168 pancreas transplant recipients (mean [SD] age: 42 [8] years; body mass index [BMI]: 23.5 [3.4] kg/m2), 1112 (51%) donors were insulin-treated. DIU was associated with a higher risk of graft loss from isolated islet failure: Odds Ratio, 95% CI 1.79 (1.05-3.07), p=0.03 and this relationship was duration/dose-dependent. DIU was also associated with a higher risk of graft loss from anastomotic leak 2.72 [1.07-6.92], p=0.04 and a lower risk of graft loss from thrombosis (0.62 [0.39-0.96], p=0.03), although duration/dose-dependent relationships was only identified in pancreas transplant alone/pancreas after kidney transplant (PTA/PAK) recipients with grafts failing due to thrombosis (0.86 [0.74-0.99], p=0.03). The relationship between donor insulin characteristics and isolated islet failure remained significant after adjusting for potential confounders: DIU 1.75 1.02-2.99), p=0.04; duration 1.08 (1.01-1.16), p=0.03. In multivariable analyses, donor insulin characteristics remained significant predictors of lower risk of graft thrombosis in PTA/PAK recipients: DIU (0.34 [0.13-0.90], p=0.03); insulin duration/dose 0.02 (0.001-0.85), p=0.04. When data on insulin was added to models predicting isolated islet failure a significant improvement in discrimination and risk reclassification was observed in all models: no DIU aROC 0.56; DIU aROC 0.57, p=0.86; NRI 0.28, p<0.00001; insulin duration aROC 0.60, p=0.47; NRI 0.35, p<0.00001. Conclusions: DIU predicts graft survival in pancreas transplant recipients. This assessment could help improve donor selection and thereby improve patient and graft outcomes.

Bibliographical metadata

Original languageEnglish
JournalDiabetologia
Publication statusAccepted/In press - 22 Dec 2020