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. This article is protected by copyright. All rights reserved.