medwireNews: The function of an islet cell graft 28 days after the last infusion predicts 5-year outcomes, show data from the Collaborative Islet Transplant Registry.
François Pattou (CHU Lille, France) and co-researchers report a dose–response relationship, with each 5-unit increase in BETA-2 score associated with a significant adjusted reduction of 23% in the risk for the transplant being unsuccessful at year 5.
The BETA-2 score was calculated from fasting C-peptide, fasting blood glucose, glycated hemoglobin (HbA1c), and daily insulin requirement.
In a commentary linked to the study published in The Lancet Diabetes & Endocrinology, Shareen Forbes (University of Edinburgh, UK) says that the score “might be considered the amalgamation of all donor and recipient factors, including unknown or poorly measured factors reflecting graft function when islet engraftment is largely complete.”
The average BETA-2 score in the study cohort was 14.3, and it was significantly higher in the 62.6% of study participants who had received multiple infusions rather than a single infusion, at 16.8 versus 10.1.
The analysis included 1210 people with type 1 diabetes from 39 international centers who underwent allogeneic pancreatic islet cell transplantation without simultaneous kidney transplantation.
These people were an average age of 47 years, 59.5% were women, and 97.9% were White. Their average diabetes duration at the time of transplant was 30.4 years, their median HbA1c was 7.8% (62 mmol/mol), and 71.4% had a history of severe hypoglycemia episodes.
Islet transplantation was unsuccessful at 28 days in 19.6% of participants; they had one or more of C-peptide below 0.2 ng/mL, HbA1c of 7.0% (53 mmol/mol) or higher, and at least one episode of severe hypoglycemia. The proportion of people with unsuccessful transplantation increased over time, to reach 70.7% by year 5.
The BETA-2 score at day 28 had good accuracy, of 70%, for predicting unsuccessful transplantation at year 5. The predicted 5-year incidence of this outcome ranged from 94% for people with a BETA-2 score of 0 to 14% for those with a score of 40.
Forbes describes the publication as “another landmark study from this important global registry that will help to inform clinical practice and guide future management of recipients of islet transplantation.”
She flags the clinical implications of the findings, suggesting that “recipients with suboptimal BETA-2 scores at 28 days after transplantation could benefit from subsequent re-transplantation.”
And she adds: “Prospective clinical trials are necessary to examine the BETA-2 score threshold at 28 days to guide re-transplantation and whether targeting islet potency early after transplantation positively affects long-term islet transplantation outcomes.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2023 Springer Healthcare Ltd, part of the Springer Nature Group
Lancet Diabetes Endocrinol 2023; doi:10.1016/S2213-8587(23)00082-7
Lancet Diabetes Endocrinol 2023; doi:10.1016/S2213-8587(23)00090-6