Peri-transplant glycaemic control as a predictor of pancreas transplant survival.
Peri-transplant glycaemic control as a predictor of pancreas transplant survival.
复制标题
围移植期血糖控制作为胰腺移植存活的预测因子。
DOI：
10.1111/dom.14181
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Shapey IM
中科院分区：
文献类型：
--
作者：
Shapey IM
目的移植围手术期血糖控制与胰腺移植后预后的关系尚不清楚。方法通过曲线下面积[AUC；平均每日血糖水平( /L) × 时间(天)]和平均每日血糖水平的变异系数来确定移植肾术后前5天的围移植期血糖控制情况。围手术期高血糖定义为AUC≥35 /d/L(日平均血糖≥7 /L)。用协变量调整的COX回归分析移植失败的风险与血糖控制和血糖变异性以及围移植期高血糖有关。结果我们收集了12 3例胰腺移植受者术后5 天的76 0 6个血糖读数。在3.6年 的随访中，血糖AUC是移植物失败的重要预测因子(未经调整的HR[95%可信区间]1.17[1.06-1.30]，P=0.002)。围移植期血糖正常的受者有8例(10%)发生非技术性移植失败，而围移植期高血糖的受者有8例(25%)发生移植物衰竭[HR(95%可信区间)：3.0(1.1-8.0)；P=0.028]。结论围移植期高血糖与移植物丢失密切相关，可作为指导个体化移植肾监测和治疗的有价值的工具。移植前后5天的葡萄糖AUC为比较移植肾功能提供了一个可靠且反应灵敏的框架。
AimsThe 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.MethodsPeri‐transplant glycaemic control profiles over the first 5 days postoperatively were determined by an area under the curve [AUC; average daily glucose level (mmol/L) × time (days)] and the coefficient of variation 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.ResultsWe collected 7606 glucose readings over 5 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% confidence interval] 1.17 [1.06‐1.30],P= .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% confidence interval): 3.0 (1.1‐8.0);P= .028].ConclusionPeri‐transplant hyperglycaemia is strongly associated with graft loss and could be a valuable tool guiding individualized graft monitoring and treatment. The 5‐day peri‐transplant glucose AUC provides a robust and responsive framework for comparing graft function.