Islet size index as a predictor of outcomes in clinical islet autotransplantation. Transplantation 2014 Jun 27;97(12):1286-91
Date
03/14/2014Pubmed ID
24621532Pubmed Central ID
PMC4682552DOI
10.1097/01.TP.0000441873.35383.1eScopus ID
2-s2.0-84902533676 (requires institutional sign-in at Scopus site) 35 CitationsAbstract
BACKGROUND: The islet size distribution in a preparation may contribute to islet transplant outcomes. At the same islet equivalent (IE) dose, larger islets may exhibit poorer therapeutic value and this may be because of oxygen diffusion limitations that worsen in proportion to islet size.
METHODS: To test this hypothesis, we studied the impact of islet size index (ISI) and other islet product characteristics on outcomes after islet autotransplant (IAT) in recipients receiving a marginal islet dose (2000-4999 IEs per kg body weight) from January 1, 2009 to June 11, 2012, at the University of Minnesota (n=58). ISI was defined as the number of IE divided by the number of islet particles (IPs) in a preparation; an ISI less than 1 indicates a mean islet diameter that is less than 150 μm. The primary post-IAT outcome was 6-month insulin use status.
RESULTS: Logistic regression analysis indicate that IPs/kg (P=0.001), IEs/kg (P=0.019), total IPs transplanted (P=0.040), and ISI (P=0.074) were most strongly correlated with the primary outcome. The ISI (mean±standard error) was lower for recipients achieving insulin independence at 6 months (0.71±0.05) versus those partially (0.83±0.05) or completely (1.00±0.07) insulin dependent. The combination of islet dose (expressed as units IPs/kg) and ISI exhibited a sensitivity of 75% and specificity of 74% in predicting insulin independence in this population of patients.
CONCLUSION: Islet autotransplant recipients of a marginal islet doses were more likely to achieve insulin independence when transplanted with a greater number of smaller islets.
Author List
Suszynski TM, Wilhelm JJ, Radosevich DM, Balamurugan AN, Sutherland DE, Beilman GJ, Dunn TB, Chinnakotla S, Pruett TL, Vickers SM, Hering BJ, Papas KK, Bellin MDAuthor
Ty Blink Dunn MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultChi-Square Distribution
Diabetes Mellitus
Female
Humans
Hypoglycemic Agents
Insulin
Islets of Langerhans
Islets of Langerhans Transplantation
Linear Models
Logistic Models
Male
Multivariate Analysis
Pancreatectomy
Pancreatitis, Chronic
Retrospective Studies
Risk Factors
Time Factors
Transplantation, Autologous
Treatment Outcome
