Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts

Debra S. Elmer, Donna Hathaway, A. Bashar Abdulkarim, Thomas A. Hughes, Hosein Shokouh-Amiri, Lillian W. Gaber, A. Osama Gaber

Research output: Contribution to journalArticle

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Abstract

We have reported that a decline in glucose disappearance rate (k(G)) in pancreas transplant recipients is associated with pancreatic rejection. The purpose of this study was to determine test-retest reliability of k(G), monitoring and to establish the k(G) criteria for diagnosing abnormal graft function. Six healthy non-diabetic volunteers and 14 stable pancreas recipients underwent 2 intravenous glucose tolerance tests 7 d apart. All k(G) values in non-diabetic volunteers had < 15% variation between the two determinations (r = 0.96, P ≤ 0.0006). Similarly, 13/14 recipients experienced < 20% variation in k(G) with one patients experiencing a 23% variation (r = 0.90, P ≤ 0.0001). Using a 20% change from baseline as the reference value, we monitored 28 pancreas recipients for 2-36 months post-transplant. Of 253 k(G) values, 160 (64%) did not exceed the 20% change from baseline, 65 (26%) declined > 20% and 28 (11%) increased > 20%. Of 160 stable k(G) values, 154 (96%) were associated with normal graft function while 6 (4%) occurred in the context of rejection. Of 65 k(G), values declining by ≤ 20%, 47 (72%) accurately identified acute rejections diagnosed by biopsy (70%) or response to treatment (30%), 12 (19%) were associated with identifiable causes of increased insulin resistance and only in 6 (9%) cases a cause for the decline was unidentifiable. The k(G) values with > 20% rise from baseline were, in 15%, associated with identifiable causes of decreased insulin resistance. The sensitivity of the k(G) as a marker for rejection was 88.7%, specificity 91%, positive predictive value 72.3%, negative predictive value 96.8%, and accuracy 90.5%. These data confirm that a > 20% deterioration of glucose disappearance rate is associated with pancreas allograft rejection, and confirms the utility of k(G) monitoring in clinical follow-up of pancreas transplant recipients.

Original languageEnglish (US)
Pages (from-to)56-64
Number of pages9
JournalClinical Transplantation
Volume12
Issue number1
StatePublished - Feb 1 1998

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Islets of Langerhans
Allografts
Pancreas
Glucose
Insulin Resistance
Volunteers
Transplants
Glucose Tolerance Test
Reproducibility of Results
Biopsy
Transplant Recipients
Therapeutics

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Elmer, D. S., Hathaway, D., Abdulkarim, A. B., Hughes, T. A., Shokouh-Amiri, H., Gaber, L. W., & Gaber, A. O. (1998). Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts. Clinical Transplantation, 12(1), 56-64.

Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts. / Elmer, Debra S.; Hathaway, Donna; Abdulkarim, A. Bashar; Hughes, Thomas A.; Shokouh-Amiri, Hosein; Gaber, Lillian W.; Gaber, A. Osama.

In: Clinical Transplantation, Vol. 12, No. 1, 01.02.1998, p. 56-64.

Research output: Contribution to journalArticle

Elmer, DS, Hathaway, D, Abdulkarim, AB, Hughes, TA, Shokouh-Amiri, H, Gaber, LW & Gaber, AO 1998, 'Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts', Clinical Transplantation, vol. 12, no. 1, pp. 56-64.
Elmer DS, Hathaway D, Abdulkarim AB, Hughes TA, Shokouh-Amiri H, Gaber LW et al. Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts. Clinical Transplantation. 1998 Feb 1;12(1):56-64.
Elmer, Debra S. ; Hathaway, Donna ; Abdulkarim, A. Bashar ; Hughes, Thomas A. ; Shokouh-Amiri, Hosein ; Gaber, Lillian W. ; Gaber, A. Osama. / Use of glucose disappearance rates (k(G)) to monitor endocrine function of pancreas allografts. In: Clinical Transplantation. 1998 ; Vol. 12, No. 1. pp. 56-64.
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