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Gołębiewska JE, Bachul PJ, Fillman N, Basto L, Kijek MR, Gołąb K, Wang LJ, Tibudan M, Thomas C, Dębska-Ślizień A, Gelrud A, Matthews JB, Millis JM, Fung J, Witkowski P. Assessment of simple indices based on a single fasting blood sample as a tool to estimate beta-cell function after total pancreatectomy with islet autotransplantation - a prospective study. Transpl Int 2018; 32:280-290. [PMID: 30353611 DOI: 10.1111/tri.13364] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
We investigated six indices based on a single fasting blood sample for evaluation of the beta-cell function after total pancreatectomy with islet autotransplantation (TP-IAT). The Secretory Unit of Islet Transplant Objects (SUITO), transplant estimated function (TEF), homeostasis model assessment (HOMA-2B%), C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr) and BETA-2 score were compared against a 90-min serum glucose level, weighted mean C-peptide in mixed meal tolerance test (MMTT), beta score and the Igls score adjusted for islet function in the setting of IAT. We analyzed values from 32 MMTTs in 15 patients after TP-IAT with a follow-up of up to 3 years. Four (27%) individuals had discontinued insulin completely prior to day 75, while 6 out of 12 patients (50%) did not require insulin support at 1-year follow-up with HbA1c 6.0% (5.5-6.8). BETA-2 was the most consistent among indices strongly correlating with all reference measures of beta-cell function (r = 0.62-0.68). In addition, it identified insulin independence (cut-off = 16.2) and optimal/good versus marginal islet function in the Igls score well, with AUROC of 0.85 and 0.96, respectively. Based on a single fasting blood sample, BETA-2 score has the most reliable discriminant value for the assessment of graft function in patients undergoing TP-IAT.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Natalie Fillman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Andres Gelrud
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- Department of Surgery, University of Chicago, Chicago, IL, USA
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2
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Gołębiewska J, Solomina J, Kijek MR, Kotukhov A, Basto L, Gołąb K, Bachul PJ, Konsur E, Ciepły K, Fillman N, Wang LJ, Thomas CC, Philipson LH, Tibudan M, Krenc A, Dębska-Ślizień A, Fung J, Witkowski P. External Validation of the Newly Developed BETA-2 Scoring System for Pancreatic Islet Graft Function Assessment. Transplant Proc 2018; 49:2340-2346. [PMID: 29198674 DOI: 10.1016/j.transproceed.2017.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND BETA-2 score using a single fasting blood sample was developed to estimate beta-cell function after islet transplantation (ITx) and was validated internally by a high ITx volume center (Edmonton). The goal was to validate BETA-2 externally, in our center. METHODS Areas under receiver operating characteristic curves (AUROCs) were obtained to see if beta score or BETA-2 would better detect insulin independence and glucose intolerance. RESULTS We analyzed values from 48 mixed meal tolerance tests (MMTTs) in 4 ITx recipients with a long-term follow-up to 140 months (LT group) and from 54 MMTTs in 13 short-term group patients (ST group). AUROC for no need for insulin support was 0.776 (95% confidence interval [CI] 0.539-1, P = .02) and 0.922 (95% CI 0.848-0.996, P < .001) for beta score and 0.79 (95% CI 0.596-0.983, P = .003) and 0.941 (95% CI 0.86-1, P < .001) for BETA-2, in LT and ST groups, respectively, and did not differ significantly. In LT group BETA-2 score ≥ 13.03 predicted no need for insulin supplementation with sensitivity of 98%, specificity of 50%, positive predictive value (PPV) of 93%, and negative predictive value (NPV) of 75%. In ST group the optimal cutoff was ≥13.63 with sensitivity of 92% and specificity, PPV, and NPV 82% to 95%. For the detection of glucose intolerance BETA-2 cutoffs were <19.43 in LT group and <17.23 in ST group with sensitivity > 76% and specificity, PPV, and NPV > 80% in both groups. CONCLUSION BETA-2 score was successfully validated externally and is a practical tool allowing for frequent and reliable assessments of islet graft function based on a single fasting blood sample.
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Affiliation(s)
- J Gołębiewska
- Department of Surgery, University of Chicago, Chicago, Illinois, USA; Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Solomina
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - M R Kijek
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Kotukhov
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L Basto
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Gołąb
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P J Bachul
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - E Konsur
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - K Ciepły
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - N Fillman
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - L-J Wang
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - C C Thomas
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - L H Philipson
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - M Tibudan
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Krenc
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Fung
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - P Witkowski
- Department of Surgery, University of Chicago, Chicago, Illinois, USA.
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3
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Gołębiewska JE, Solomina J, Thomas C, Kijek MR, Bachul PJ, Basto L, Gołąb K, Wang LJ, Fillman N, Tibudan M, Ciepły K, Philipson L, Dębska-Ślizień A, Millis JM, Fung J, Witkowski P. Comparative evaluation of simple indices using a single fasting blood sample to estimate beta cell function after islet transplantation. Am J Transplant 2018; 18:990-997. [PMID: 29218834 DOI: 10.1111/ajt.14620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/17/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Six single fasting blood sample-based indices-Secretory Unit of Islet Transplant Objects (SUITO), Transplant Estimated Function (TEF), Homeostasis Model Assessment (HOMA)2-B%, C-peptide/glucose ratio (CP/G), C-peptide/glucose creatinine ratio (CP/GCr), and BETA-2 score-were compared against commonly used 90-minute mixed meal tolerance test (MMTT) serum glucose and beta score to assess which of them best recognizes the state of acceptable blood glucose control without insulin supplementation after islet allotransplantation (ITx). We also tested whether the indices could identify the success of ITx based on the Igls classification of beta cell graft function. We analyzed values from 47 MMTT tests in 4 patients with up to 140 months follow-up and from 54 MMTT tests in 13 patients with up to 42 months follow-up. SUITO, CP/G, HOMA2-B%, and BETA-2 correlated well with the 90-minute glucose of the MMTT and beta-score (r 0.54-0.76), whereas CP/GCr showed a modest performance (r 0.41-0.52) while TEF showed little correlation. BETA-2 and SUITO were the best identifiers and predictors of the need for insulin support, glucose intolerance, and ITx success (P < .001), while HOMA2-B% and TEF were unreliable. Single fasting blood sample SUITO and BETA-2 scores are very practical alternative tools that allow for frequent assessments of graft function.
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Affiliation(s)
- Justyna E Gołębiewska
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Julia Solomina
- Department of Surgery, University of Chicago, Chicago, IL
| | - Celeste Thomas
- Department of Medicine, University of Chicago, Chicago, IL
| | - Mark R Kijek
- Department of Surgery, University of Chicago, Chicago, IL
| | - Piotr J Bachul
- Department of Surgery, University of Chicago, Chicago, IL.,Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lindsay Basto
- Department of Surgery, University of Chicago, Chicago, IL
| | - Karolina Gołąb
- Department of Surgery, University of Chicago, Chicago, IL
| | - Ling-Jia Wang
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Martin Tibudan
- Department of Surgery, University of Chicago, Chicago, IL
| | - Kamil Ciepły
- Department of Surgery, University of Chicago, Chicago, IL
| | | | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, IL
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Matsumoto S, Takita M, Shimoda M, Itoh T, Iwahashi S, Chujo D, SoRelle JA, Tamura Y, Rahman A, Purcell K, Onaca N, Naziruddin B, Levy MF. Usefulness of the secretory unit of islet transplant objects (SUITO) index for evaluation of clinical autologous islet transplantation. Transplant Proc 2014; 43:3246-9. [PMID: 22099768 DOI: 10.1016/j.transproceed.2011.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Assessing the engrafted islet mass is important in evaluating the efficacy of islet transplantation. We previously demonstrated that the average secretory unit of islet transplant objects (SUITO) index within 1 month of allogeneic islet transplantation was an excellent predictor of insulin independence. However, the usefulness of the SUITO index for evaluating autologous islet transplantation has not been explored. The purpose of the present study was to assess the relationship between the SUITO index and clinical outcomes after total pancreatectomy followed by autologous islet transplantation. METHODS We performed 27 total pancreatectomies followed by autologous islet transplantation from October 2006 to January 2011. Cases were divided into an insulin-independent group (IIG; n = 12) and an insulin-dependent group (lDG; n = 15). The SUITO index was calculated by the formula [fasting C-peptide (ng/mL)/fasting glucose (mg/dL) -63] × 1,500. The average SUITO index within the first month of transplantation except for days 0, 1, and 2, maximum SUITO index, and most recent SUITO index were calculated in each case, and values were compared between the IIG and the IDG. RESULTS The average SUITO index within 1 month was significantly higher in the IIG than in the IDG (24.6 ± 3.4 vs 14.9 ± 2.0, respectively; P < .02). The maximum SUITO indices were 45.7 ± 7.7 in the IIG and 30.1 ± 8.1 in the IDG (not significant), and the recent SUITO indices were 36.9 ± 6.7 in the IIG and 22.8 ± 6.1 in the IDG (not significant). CONCLUSIONS The average SUITO index within 1 month was an excellent predictor of insulin independence after total pancreatectomy followed by autologous islet transplantation.
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Affiliation(s)
- S Matsumoto
- Baylor Research Institute, Dallas, Texas, USA.
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5
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Takita M, Matusmoto S. SUITO index for evaluation of clinical islet transplantation. Cell Transplant 2013; 21:1341-7. [PMID: 22472135 DOI: 10.3727/096368912x636885] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The major endpoints for clinical islet transplantation for type 1 diabetes are insulin independence and reduction of hypoglycemic episodes. Both endpoints are influenced by patients' and physicians' preferences regarding the use of exogenous insulin. Therefore, development of an objective endpoint for assessing clinical islet transplantation is desirable. HOMA-beta score is useful in assessing functional β-cell mass. However, this score uses blood insulin levels that are influenced by exogenous insulin injection and therefore is not suitable for patients who receive exogenous insulin. For assessing functional β-cell mass for type 1 diabetic patients after islet transplantation, we created the Secretory Unit of Islet Transplant Objects (SUITO) index using fasting C-peptide and fasting glucose. The formula of the SUITO index is fasting C-peptide (ng/ml)/[fasting blood glucose − 63 (mg/dl)] × 1500. We demonstrated that, within 1 month of islet transplantation, an average SUITO index of >26 was an excellent predictor of achieving insulin independence. In addition, daily SUITO index scores correlated with a reduction of insulin dose and adversely correlated with blood glucose levels during an intravenous glucose tolerance test. Other important endpoints, reduction of hypoglycemic episodes and quality of life, also correlated with the SUITO index. Thus, the SUITO index is excellent for assessing important endpoints (insulin independence, reduction of hypoglycemia, improved quality of life) after allogeneic islet transplantation.
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Affiliation(s)
- Morihito Takita
- Baylor Research Institute, 1400 8th Ave., Fort Worth, TX 76104, USA.
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Hirsch D, Odorico J, Danobeitia JS, Alejandro R, Rickels MR, Hanson M, Radke N, Baidal D, Hullett D, Naji A, Ricordi C, Kaufman D, Fernandez L. Early metabolic markers that anticipate loss of insulin independence in type 1 diabetic islet allograft recipients. Am J Transplant 2012; 12:1275-89. [PMID: 22300172 PMCID: PMC4569145 DOI: 10.1111/j.1600-6143.2011.03947.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The objective of this study was to identify predictors of insulin independence and to establish the best clinical tools to follow patients after pancreatic islet transplantation (PIT). Sequential metabolic responses to intravenous (I.V.) glucose (I.V. glucose tolerance test [IVGTT]), arginine and glucose-potentiated arginine (glucose-potentiated arginine-induced insulin secretion [GPAIS]) were obtained from 30 patients. We determined the correlation between transplanted islet mass and islet engraftment and tested the ability of each assay to predict return to exogenous insulin therapy. We found transplanted islet mass within an average of 16 709 islet equivalents per kg body weight (IEQ/kg BW; range between 6602 and 29 614 IEQ/kg BW) to be a poor predictor of insulin independence at 1 year, having a poor correlation between transplanted islet mass and islet engraftment. Acute insulin response to IVGTT (AIR(GLU) ) and GPAIS (AIR(max) ) were the most accurate methods to determine suboptimal islet mass engraftment. AIR(GLU) performed 3 months after transplant also proved to be a robust early metabolic marker to predict return to insulin therapy and its value was positively correlated with duration of insulin independence. In conclusion, AIR(GLU) is an early metabolic assay capable of anticipating loss of insulin independence at 1 year in T1D patients undergoing PIT and constitutes a valuable, simple and reliable method to follow patients after transplant.
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Affiliation(s)
- D. Hirsch
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - J. Odorico
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - J. S. Danobeitia
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - R. Alejandro
- Department of Medicine, Division of Endocrinology, University of Miami School of Medicine, Miami, FL
| | - M. R. Rickels
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - M. Hanson
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - N. Radke
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - D. Baidal
- Department of Medicine, Division of Endocrinology, University of Miami School of Medicine, Miami, FL
| | - D. Hullett
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - A. Naji
- Department of Surgery, Division of Transplantation, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - C. Ricordi
- Department of Surgery, Microbiology and Immunology, University of Miami, Miami, FL
| | - D. Kaufman
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - L. Fernandez
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
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Association Between the Secretory Unit of Islet Transplant Objects Index and Satisfaction With Insulin Therapy Among Insulin-Dependent Islet Recipients. Transplant Proc 2011; 43:3250-5. [DOI: 10.1016/j.transproceed.2011.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Takita M, Matsumoto S, Qin H, Noguchi H, Shimoda M, Chujo D, Itoh T, Sugimoto K, Onaca N, Naziruddin B, Levy MF. Secretory unit of islet transplant objects (SUITO) index can predict severity of hypoglycemic episodes in clinical islet cell transplantation. Cell Transplant 2011; 21:91-8. [PMID: 21669043 DOI: 10.3727/096368911x580617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
One endpoint of clinical islet cell transplantation for type 1 diabetic patients is the elimination or reduction of hypoglycemia. We previously developed a simple tool to evaluate islet graft function: the secretory unit of islet transplant objects (SUITO) index. The aim of this study is to clarify the association between the SUITO index and hypoglycemic episodes. Data from 310 clinical evaluations of 11 islet recipients were included in this study. Fasting plasma C-peptide and glucose levels were measured at every evaluation. The SUITO index was calculated according to the following formula: 1500 × C-peptide level (ng/ml)/[blood glucose level (mg/dl) - 63]. The number of hypoglycemic events (<3.8 mmol/L) and severe hypoglycemic events (<2.2 mmol/L or hypoglycemic unawareness) was assessed on the basis of interviews and self-monitoring of blood glucose (SMBG). Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values of the SUITO index for hypoglycemic events. Based on the ROC study, follow-up data after transplantations were divided into the following three groups: low-SUITO (SUITO index <10, n = 91), middle-SUITO (10 ≤SUITO index <26, n = 83), high-SUITO (SUITO index ≤26, n = 125). The frequency of total hypoglycemia in the high-SUITO group was significantly decreased when compared to the other groups (value with Kruskal-Wallis test p < 0.001). The frequency of total severe hypoglycemia was significantly decreased in the low-SUITO group compared to pretransplant status and further decreased in the middle- and high-SUITO group. Spearman correlation coefficients were -0.663 (p < 0.001) between the number of total hypoglycemic events per one month and the SUITO index and -0.521 (p < 0.001) between that of severe events and the SUITO index. The SUITO index could predict the severity of hypoglycemic episodes in type 1 diabetic patients who received islet cell transplantations.
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Affiliation(s)
- Morihito Takita
- Islet Cell Laboratory, Baylor Research Institute Fort Worth Campus, Fort Worth, TX, USA
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