RESUMO
We evaluated whether 1,5-anhydroglucitol (1,5-AG) (GlycoMark(®)), a test for measuring postprandial glucose and glucose variability, could be a tool for assessing short-term glycemic control in islet cell transplant (ICT) subjects. Data of 21 subjects, with type 1 DM and allogenic islet transplantation, who had concomitant fructosamine, HbA1c, 1,5-AG (n = 85 samples), and capillary glucose self-monitoring measurements (n = 2,979) were analyzed retrospectively at different time points after ICT. A significant negative association was observed between 1,5-AG and HbA1c (p = 0.02), but not with fructosamine. When HbA1c was divided in quartiles as <5.6, 5.6-5.9, 5.9-6.2, and >6.2, a decrease of an estimated 0.70 ± 0.30 µg/ml in 1,5-AG was associated with each quartile of increase in HbA1c (p < 0.0001). There was a significant decline of 1.64 ± 0.3mg/dl in postprandial glucose values for each 1 unit increase in 1,5-AG (p < 0.0001). For those with HbA1c ≥ 6.0% when 1,5-AG was ≥8.15 µg/ml, the mean estimated glucose level was 103.71 ± 3.66 mg/dl, whereas it was 132.12 ± 3.71 mg/dl when 1,5-AG was <8.15 µg/ml. The glucose variability (Glumax - Glumin) in subjects with 1,5-AG <8.15 µg/ml was 46.23 mg/dl greater than the subjects with 1,5-AG ≥8.15 µg/ml (HbA1c ≥ 6.0%). There was no significant association between GlycoMark and glucose variability where HbA1c < 6%. 1,5-AG significantly associated with postprandial glucose levels and glucose variability in ICT recipients with near-normal HbA1c (6.0-6.5%) levels. These findings suggest that 1,5-AG can be used to differentiate those ICT subjects with higher glucose variability despite having near-normal HbA1c. However, prospective studies are needed to evaluate the association between GlycoMark levels and the parameters of graft dysfunction/failure.
Assuntos
Glicemia/metabolismo , Desoxiglucose/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/terapia , Hemoglobinas Glicadas/metabolismo , Transplante das Ilhotas Pancreáticas/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Estudos Retrospectivos , TransplantadosAssuntos
Hematoma/etiologia , Hematoma/cirurgia , Transplante das Ilhotas Pancreáticas/efeitos adversos , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Angiografia , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemodinâmica , Hemorragia , Humanos , Imunossupressores/uso terapêutico , Fígado/lesões , Fígado/patologia , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: In a retrospective study of the first 75 primary renal transplant patients given alemtuzumab induction at our center, 20 were African American (27%), 32 were Hispanic (43%), and 23 were non-African American, non-Hispanic (31%). METHODS: Alemtuzumab was given intraoperatively and 4 days later (0.3 mg/kg), with planned low-dose maintenance mycophenolate mofetil (500 mg twice daily) and tacrolimus (targeted trough levels of 5 to 7 ng/ml) and no corticosteroid therapy after the first week. Median follow-up among ongoing survivors with a functioning graft was 45 months. RESULTS: Three-year actuarial patient and graft survival rates were 95% and 85% in African Americans, 89% and 78% in Hispanics, and 96% and 96% in non-African Americans, non-Hispanics, respectively (not significant). Bioavailability of tacrolimus was significantly lower among African Americans in comparison with the other patient subgroups (PAssuntos
Anticorpos Monoclonais/uso terapêutico
, Anticorpos Antineoplásicos/uso terapêutico
, Transplante de Rim/imunologia
, Adulto
, Alemtuzumab
, Anticorpos Monoclonais Humanizados
, Antineoplásicos/uso terapêutico
, População Negra
, Causas de Morte
, Feminino
, Seguimentos
, Rejeição de Enxerto/tratamento farmacológico
, Rejeição de Enxerto/epidemiologia
, Sobrevivência de Enxerto
, Hispânico ou Latino
, Teste de Histocompatibilidade
, Humanos
, Imunossupressores/uso terapêutico
, Transplante de Rim/efeitos adversos
, Transplante de Rim/mortalidade
, Masculino
, Pessoa de Meia-Idade
, Preservação de Órgãos
, Complicações Pós-Operatórias/epidemiologia
, Estudos Retrospectivos
, Análise de Sobrevida
, Doadores de Tecidos/estatística & dados numéricos
RESUMO
INTRODUCTION: A long-term prospective randomized trial evaluating alemtuzumab, a humanized anti-CD52 monoclonal antibody, in a predominantly non-Caucasian population has yet to be reported. METHODS: Ninety deceased donor (DD) first renal transplant recipients were randomized into three different antibody induction groups: group A, thymoglobulin (Thymo); group B, alemtuzumab; group C, daclizumab (Dac). In groups A and C, the target trough levels of tacrolimus were 8-10 ng/mL, mycophenolate mofetil (MMF) 1 g administered twice daily, and maintenance methylprednisolone. In group B, target tacrolimus trough levels were 4-7 ng/mL, 500 mg MMF administered twice-daily, without methylprednisolone. African-Americans and Hispanics comprised more than 50% in each group. RESULTS: A minimum follow-up of 27 months showed no overall group differences in patient or graft survival (p = 0.89 and 0.66), but a trend towards worse death-censored graft survival in group B (p = 0.05). Acute rejection rates were not significantly different: six (20%), seven (23%), and seven (23%) in groups A, B, and C, respectively. The incidence of chronic allograft nephropathy was higher in group B than in A and C (p = 0.008). The mean calculated creatinine clearance at 24 months was 81.1 +/- 5.5, 64.4 +/- 4.5, and 80.7 +/- 5.7 in groups A, B, and C, respectively (p = 0.01 for B vs. average of A and C). CONCLUSION: In this randomized 27-month minimum follow-up trial of predominantly non-Caucasian DD renal transplant recipients with alemtuzumab induction, lower maintenance tacrolimus, MMF, and steroid avoidance appear less effective than either Thymo or Dac with higher maintenance immunosuppression.