External Validation of the Newly Developed BETA-2 Scoring System for Pancreatic Islet Graft Function Assessment

Gołębiewska, Justyna; Solomina, Julia; Kijek, Mark; Kotukhov, A.; Basto, Lindsay; Gołąb, Karolina; Bachul, Piotr J.; Konsur, Evelyn; Cieply, Kamil; Fillman, Natalie; Wang, L.-j.; Thomas, Chinnamma; Philipson, Louis H.; Tibudan, Martin; Krenc, Agata K.; Dębska-Ślizień, Alicja; Fung, John J.; Witkowski, Piotr

doi:10.1016/j.transproceed.2017.10.011

Cited by 7 publications

(12 citation statements)

References 15 publications

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“…Our results indicate that BETA-2 and TEF could safely be implemented in the assessment and management of glucose control in patients after TP-IAT. TEF outperformed other surrogate indices in the AUROC analysis unlike in our previous analysis in allogenic islet transplant recipients [21]. However, BETA-2 showed the strongest correlation with all the reference beta-cell function measures in the current study, and was found very efficient not only in auto-but also in allotransplantation.…”

Section: Discussioncontrasting

confidence: 76%

“…It is particularly important that all the cut‐offs for detection of the need for insulin support are similar to those in allogenic islet transplantation recipients: BETA‐2 score below 13 indicating insulin dependence, between 13 and 18 signifying glucose intolerance and score over 18 was correlated with insulin independence . Due to a limited number of MMTT measurements in our patients, we stratified patients only as “on insulin” and “off insulin” and found a cut‐off of 16.2, which is in the middle between 13 and 18 found in islet allograft patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, those indices were developed primarily for islet graft assessment after allotransplantation in patients with T1DM. We previously demonstrated the indices reliability in patients with islet allografts, especially BETA‐2 score and SUITO . It is uncertain whether these surrogate indices can also accurately assess function of islet autografts.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2018

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Summary 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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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2018

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“…BETA‐2 showed >88% specificity and sensitivity in detecting insulin independence with a cut‐off of 15, whereas a BETA‐2 cut‐off of 20 had >82% sensitivity and specificity in detecting glucose intolerance . Our subsequent external BETA‐2 validation presented very similar results . We also used BETA‐2 to measure islet graft function on day 75 and found that it can also predict insulin independence at 1 year posttransplantation (AUC = 0.942 [0.869‐1]) ( P = .001) .…”

Section: Discussionmentioning

confidence: 72%

BETA-2 score is an early predictor of graft decline and loss of insulin independence after pancreatic islet allotransplantation

Bachul

Gołębiewska

Basto

et al. 2020

American Journal of Transplantation

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This study aimed to evaluate whether the BETA‐2 score is a reliable early predictor of graft decline and loss of insulin independence after islet allotransplantation. Islet transplant procedures were stratified into 3 groups according to clinical outcome: long‐term insulin independence without islet graft decline (group 1, N = 9), initial insulin independence with subsequent islet graft decline and loss of insulin independence (group 2, N = 13), and no insulin independence (group 3, N = 13). BETA‐2 was calculated on day 75 and multiple times afterwards for up to 145 months posttransplantation. A BETA‐2 score cut‐off of 17.4 on day 75 posttransplantation was discerned between group 1 and groups 2 and 3 (area under the receiver operating characteristic 0.769, P = .005) with a sensitivity and negative predictive value of 100%. Additionally, BETA‐2 ≥ 17.4 at any timepoint during follow‐up reflected islet function required for long‐term insulin independence. While BETA‐2 did not decline below 17.4 for each of the 9 cases from group 1, the score decreased below 17.4 for all transplants from group 2 with subsequent loss of insulin independence. The reduction of BETA‐2 below 17.4 predicted 9 (1.5‐21) months in advance subsequent islet graft decline and loss of insulin independence (P = .03). This finding has important implications for posttransplant monitoring and patient care.

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“…Some studies have demonstrated that a positive C-peptide before pancreas transplantation was not associated with worse patient or graft survival [15]. In the field of islet transplantation, C-peptide is a component of the β-Score which is routinely used to estimate beta cell functionality [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Clinical utility of C‐peptide measurement after pancreas transplantation with especial focus on early graft thrombosis

et al. 2021

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Since the beginning of our pancreas transplant programme, plasma C-peptide was routinely measured daily during the postoperative period. We aimed to evaluate the clinical interest of the C-peptide in the follow-up of pancreas transplantation with a particular look on early graft failure. From 2000 to 2016, 384 pancreas transplantations were evaluated. We collected and compared C-peptide, glycaemia and adjusted C-peptide (aCP; calculated based on C-peptide, glycaemia and creatininaemia) in patients with and without pancreas failure within 30 days after surgery. Variations of glycaemia, C-peptide and aCP between the day before and the day of failure were also recorded. The difference of aCP was significant during the first week after transplantation between patients with thrombosis and those with functional allograft: 63.2 vs. 26.7 on day 1, P = 0.0003; 61.4 vs. 26.7 on day 3, P < 0.0001; 64.8 vs. 5.7 on day 7, P < 0.0001, respectively. Glycaemia had a median increase of 8% on the day of failure, whereas C-peptide and aCP had, respectively, a median decrease of 88% and 83%. Cpeptide monitoring after pancreas transplantation may help to identify graft function and early failure. This sensitive biomarker could allow preemptive diagnosis of an early thrombotic event allowing the possibility of rescue interventions.

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External Validation of the Newly Developed BETA-2 Scoring System for Pancreatic Islet Graft Function Assessment

Abstract: 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.

Cited by 7 publications

References 15 publications

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

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

BETA-2 score is an early predictor of graft decline and loss of insulin independence after pancreatic islet allotransplantation

Clinical utility of C‐peptide measurement after pancreas transplantation with especial focus on early graft thrombosis

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