Casey Ward1,2, Jon S Odorico2, Michael R Rickels3, Thierry Berney4, George W Burke5, Thomas W H Kay6, Olivier Thaunat7, Pablo D Uva8, Eelco J P de Koning9, Helmut Arbogast10, Hanne Scholz11, Mark S Cattral12, Robert J Stratta13, Peter G Stock1. 1. Division of Transplantation, Department of Surgery, University of California, San Francisco, San Francisco, CA. 2. Department of Surgery, Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON. 3. Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 4. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, and Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5. Division of Transplantation and Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland. 6. Division of Transplantation, Department of Surgery, and Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL. 7. Department of Medicine, St. Vincent's Hospital, St. Vincent's Institute of Medical Research, University of Melbourne, Melbourne, VIC, Australia. 8. Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 9. Department of Kidney Pancreas Transplantation, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina. 10. Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands. 11. Department of General, Visceral and Transplant Surgery, University Hospital Grosshadern, Ludwig Maximilian's University, Munich, Germany. 12. Department of Transplant Medicine and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway. 13. Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
Abstract
BACKGROUND: The long-term outcomes of both pancreas and islet allotransplantation have been compromised by difficulties in the detection of early graft dysfunction at a time when a clinical intervention can prevent further deterioration and preserve allograft function. The lack of standardized strategies for monitoring pancreas and islet allograft function prompted an international survey established by an International Pancreas and Islet Transplant Association/European Pancreas and Islet Transplant Association working group. METHODS: A global survey was administered to 24 pancreas and 18 islet programs using Redcap. The survey addressed protocolized and for-cause immunologic and metabolic monitoring strategies following pancreas and islet allotransplantation. All invited programs completed the survey. RESULTS: The survey identified that in both pancreas and islet allograft programs, protocolized clinical monitoring practices included assessing body weight, fasting glucose/C-peptide, hemoglobin A1c, and donor-specific antibody. Protocolized monitoring in islet transplant programs relied on the addition of mixed meal tolerance test, continuous glucose monitoring, and autoantibody titers. In the setting of either suspicion for rejection or serially increasing hemoglobin A1c/fasting glucose levels postpancreas transplant, Doppler ultrasound, computed tomography, autoantibody titers, and pancreas graft biopsy were identified as adjunctive strategies to protocolized monitoring studies. No additional assays were identified in the setting of serially increasing hemoglobin A1c levels postislet transplantation. CONCLUSIONS: This international survey identifies common immunologic and metabolic monitoring strategies utilized for protocol and for cause following pancreas and islet transplantation. In the absence of any formal studies to assess the efficacy of immunologic and metabolic testing to detect early allograft dysfunction, it can serve as a guidance document for developing monitoring algorithms following beta-cell replacement.
BACKGROUND: The long-term outcomes of both pancreas and islet allotransplantation have been compromised by difficulties in the detection of early graft dysfunction at a time when a clinical intervention can prevent further deterioration and preserve allograft function. The lack of standardized strategies for monitoring pancreas and islet allograft function prompted an international survey established by an International Pancreas and Islet Transplant Association/European Pancreas and Islet Transplant Association working group. METHODS: A global survey was administered to 24 pancreas and 18 islet programs using Redcap. The survey addressed protocolized and for-cause immunologic and metabolic monitoring strategies following pancreas and islet allotransplantation. All invited programs completed the survey. RESULTS: The survey identified that in both pancreas and islet allograft programs, protocolized clinical monitoring practices included assessing body weight, fasting glucose/C-peptide, hemoglobin A1c, and donor-specific antibody. Protocolized monitoring in islet transplant programs relied on the addition of mixed meal tolerance test, continuous glucose monitoring, and autoantibody titers. In the setting of either suspicion for rejection or serially increasing hemoglobin A1c/fasting glucose levels postpancreas transplant, Doppler ultrasound, computed tomography, autoantibody titers, and pancreas graft biopsy were identified as adjunctive strategies to protocolized monitoring studies. No additional assays were identified in the setting of serially increasing hemoglobin A1c levels postislet transplantation. CONCLUSIONS: This international survey identifies common immunologic and metabolic monitoring strategies utilized for protocol and for cause following pancreas and islet transplantation. In the absence of any formal studies to assess the efficacy of immunologic and metabolic testing to detect early allograft dysfunction, it can serve as a guidance document for developing monitoring algorithms following beta-cell replacement.
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Authors: Cyril P Landstra; Axel Andres; Mikael Chetboun; Caterina Conte; Yvonne Kelly; Thierry Berney; Eelco J P de Koning; Lorenzo Piemonti; Peter G Stock; François Pattou; Marie-Christine Vantyghem; Melena D Bellin; Michael R Rickels Journal: J Clin Endocrinol Metab Date: 2021-09-27 Impact factor: 6.134