Between November 1977 and January 1987, 55 transplantations of pancreas segments from living donors related to their recipients were performed at the University of Minnesota. A preliminary analysis of metabolic test results in donors tested 1 yr after hemipancreatectomy showed an increase in mean glucose and a decrease in mean insulin values during oral glucose tolerance tests (OGTTs) in 18 donors, a 14% increase in the mean of the mean glucose levels during 24-h metabolic profiles in 12 donors, and a decrease of 45% in the mean 24-h urinary C-peptide excretion in 21 donors. Including the studies performed postdonation, 11 of 31 (35%) donors developed an abnormal OGTT result. In a retrospective analysis, preoperative results of intravenous glucose tolerance tests (IVGTTs) and cortisonestimulated OGTTs were found to be statistically significant predictors of an abnormal OGTT after hemipancreatectomy. The mean of the 5- to 50-min IVGTT insulin values was the best predictive test. With the cutoff value set at 62 μU/ml, this test result had a sensitivity of 100% a specificity of 83%, and a positive predictive value of 75% for identifying donors who developed an abnormal OGTT. The sum of the 5- and 10-min IVGTT insulin (cutoff 140 μU/ml) had a sensitivity of 100%, a specificity of 67, and a predictive value of only 60%, whereas the Δ-insulin had values of 86, 71, and 60%, respectively. Both the IVGTT mean insulin and the sum of the 5-min and 10-min insulin test results were 100% predictive of an abnormal test (0% risk), but the IVGTT mean insulin excluded the lowest proportion of otherwise suitable donors (a low “false-alarm” rate). The IVGTT mean insulin can be used to identify or exclude potential donors who would develop an abnormal OGTT result should hemipancreatectomy be performed.
Metabolic Effect of Hemipancreatectomy in Donors: Preoperative Prediction of Postoperative Oral Glucose Tolerance
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David M Kendall, David ER Sutherland, Frederick C Goetz, John S Najarian; Metabolic Effect of Hemipancreatectomy in Donors: Preoperative Prediction of Postoperative Oral Glucose Tolerance. Diabetes 1 January 1989; 38 (Supplement_1): 101–103. https://doi.org/10.2337/diab.38.1.S101
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