EZIO BONIFACIO, PHD
6LORENZO PIEMONTI, MD 6 OBJECTIVE -The -score is a highly regarded approach to the assessment of transplant functionality. Our aim was to develop an index of -cell function that hinges on the pillars of the -score (daily insulin requirement and A1C), has a straightforward physiological interpretation, and does not require the execution of an insulin stimulation test.
RESEARCH DESIGN AND METHODS -The new index is denoted transplant estimated function (TEF) and is obtained from the daily insulin requirement and A1C. TEF estimates the amount of insulin secreted daily and can be normalized to the number of transplanted islets, thus permitting evaluation of the cost-effectiveness of the transplant. TEF was compared with the area under the curve of C-peptide [AUC(C-pep)] concentration over 24 h, as well as the acute insulin response to intravenous glucose (AIR glu ) and to arginine (AIR arg ). The association between TEF and -score was also investigated.RESULTS -The correlation of TEF with 24-h AUC(C-pep) was r ϭ 0.73 (P Ͻ 0.005), whereas that for -score versus 24-h AUC(C-pep) was r ϭ 0.33 (NS). The correlation of TEF with AIR glu was r ϭ 0.59 (P Ͻ 0.001) and close to that for -score versus AIR glu (r ϭ 0.65, P Ͻ 0.001). The correlation of TEF with AIR arg was r ϭ 0.33 (P Ͻ 0.005) and was similar to that for -score versus AIR arg (r ϭ 0.34, P Ͻ 0.005). TEF and -score were correlated well (r ϭ 0.69, P Ͻ 0.0001) and showed similar time profiles.CONCLUSIONS -TEF estimates daily insulin secretion, it is simpler than the -score, and its performance against reference indexes of -cell secretion is in line with that exhibited by -score. TEF can be normalized to the number of transplanted islets and thereby provides a benchmarking tool to evaluate the cost-effectiveness of the transplant.