We have reported that a decline in glucose disappearance rate (k) in pancreas transplant recipients is associated with pancreatic rejection. The purpose of this study was to determine test‐retest reliability of kG monitoring and to establish the kG criteria for diagnosing abnormal graft function. Six healthy non‐diabetic volunteers and 14 stable pancreas recipients underwent 2 intravenous glucose tolerance tests 7 d apart. All kG values in non‐diabetic volunteers had < 15% variation between the two determinations (r = 0.96, P ≤ 0.0006). Similarly, 13/14 recipients experienced <20% variation in kG with one patients experiencing a 23% variation (r = 0.90, P ≤ 0.0001). Using a 20% change from baseline as the reference value, we monitored 28 pancreas recipients for 2‐36 months post‐transplant. Of 253 kG values, 160 (64%) did not exceed the 20% change from baseline, 65 (26%) declined > 20% and 28 (11%) increased > 20%. Of 160 stable kG values, 154 (96%) were associated with normal graft function while 6 (4%) occurred in the context of rejection. Of 65 kG values declining by ≥ 20%, 47 (72%) accurately identified acute rejections diagnosed by biopsy (70%) or response to treatment (30%), 12 (19%) were associated with identifiable causes of increased insulin resistance and only in 6 (9%) cases a cause for the decline was unidentifiable. The kG values with > 20% rise from baseline were, in 15%, associated with identifiable causes of decreased insulin resistance. The sensitivity of the kG as a marker for rejection was 88.7%, specificity 91%, positive predictive value 72.3%, negative predictive value 96.8%, and accuracy 90.5%. These data confirm that a > 20% deterioration of glucose disappearance rate is associated with pancreas allograft rejection, and confirms the utility of k monitoring in clinical follow‐up of pancreas transplant recipients.
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Elmer et al. (1998) studied this question.