Peri-transplant glycaemic control as a predictor of pancreas transplant survival

Aims
The relationship between peri‐transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri‐transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction.

Methods
Peri‐transplant glycaemic control profiles over the first five days postoperatively were determined by an area under the curve (AUC; average daily glucose level (mmol/L) x time (days)) and the coefficient of variation (CV) of mean daily glucose levels. Peri‐transplant hyperglycaemia was defined as an AUC ≥35 mmol.day/L (daily mean blood glucose ≥7 mmol/L). Risks of graft failure associated with glycaemic control and variability and peri‐transplant hyperglycaemia were determined using covariate‐adjusted Cox regression.

Results
We collected 7606 glucose readings over five days postoperatively from 123 pancreas transplant recipients. Glucose AUC was a significant predictor of graft failure during 3.6 years of follow‐up (unadjusted HR [95%CI] 1.17 [1.06–1.30], p = 0.002). Death censored non‐technical graft failure occurred in eight (10%) recipients with peri‐transplant normoglycaemia, and eight (25%) recipients with peri‐transplant hyperglycaemia such that hyperglycaemia predicted a 3‐fold higher risk of graft failure (HR (95% CI): 3.0 (1.1–8.0); p = 0.028).

Conclusion
Peri‐transplant hyperglycaemia is strongly associated with graft loss and could be a valuable tool guiding individualised graft monitoring and treatment. The five‐day peri‐transplant glucose AUC provides a robust and responsive framework for comparing graft function.