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

Am J Transplant. 2020 Mar;20(3):844-851. doi: 10.1111/ajt.15645. Epub 2019 Nov 13.

Abstract

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.

Keywords: clinical research/practice; diabetes: type 1; islet transplantation; islets of Langerhans; quality of care/care delivery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Glucose
  • C-Peptide
  • Diabetes Mellitus, Type 1* / surgery
  • Humans
  • Insulin
  • Islets of Langerhans Transplantation*
  • Islets of Langerhans*

Substances

  • Blood Glucose
  • C-Peptide
  • Insulin