202 Can post-transplant C-Peptide be used as an indicator of pancreas graft failure?
Monday November 16, 2015 from 07:00 to 08:00
Room 110

Jonathan A. Fridell, United States

Director of Pancreas Transplantation


Indiana University School of Medicine


Can post-transplant C-Peptide be used as an indicator of pancreas graft failure?

Robert Carrico2, Jonathan Fridell MD1, Jon Odorico MD3, Robert Stratta MD4, Kristina Tyler2, Silke Niederhaus MD5, Raja Kandaswamy MD6, Jonathan Fisher MD7, Oyedolamu Olaitan MD8, Muhammad Mujtaba MD9.

1Surgery, Indiana University, Indianapolis, IN, United States; 2Research, United Network for Organ Sharing, Richmond, VA, United States; 3Surgery, University of Wisconsin, Madison, WI, United States; 4Transplant Surgery, Wake Forest Baptist Health, Winston-Salem, NC, United States; 5Surgery, University of Maryland, Baltimore, MD, United States; 6Surgery, University of Minnesota, Minneapolis, MN, United States; 7Surgery, Scripps Health, La Jolla, CA, United States; 8Transplant, Rush University, Chicago, IL, United States; 9Internal Medicine, University of Texas, Galveston, TX, United States

Background: The OPTN Pancreas Transplantation Committee is attempting to define pancreas graft failure and performed a study to determine if C-peptide corresponds to pancreas graft failure as reported to the OPTN.
Methods: C-peptide data from 7 participating centers (n=415 graft failures for transplants from 2002-2012) were collected and analyzed after IRB approval.  C-peptide values pre-transplant as well as at center-determined graft failure and return to insulin were analyzed for trends between time points.
Results: A total of 233 C-peptide values were submitted at graft failure, 149 values submitted for pre-transplant, and 94 at return to insulin. There were 77 transplants with values at both pre-transplant and graft failure. For recipients in the study who had C-peptide <1 ng/ml pre-transplant and had a post-transplant C-peptide value (n=61), graft failure was declared at varying levels of C-peptide. High C-peptide values at graft failure were not explained by stimulated testing (6% stimulated, 89% fasting, 5% unknown), or by single-center bias. Of the 36 recipients with values at all 3 points, 30 returned to insulin at graft failure.

Conclusions: Centers declare graft failure at varying levels of C-peptide and do not consistently collect C-peptide on patients. Either C-peptide is not used for evaluating graft function, or other factors influence reporting of graft failure. These data do not support use of C-peptide as a criteria for the definition of pancreas graft failure.  Obtaining a better understanding of the etiology of pancreas graft failures nationally is hindered by limited objective data collected on OPTN forms and by center-declared graft status.

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