One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study
Understanding which factors shape long-term pancreas graft outcomes after the critical first year post-transplantation is an ongoing challenge. This study assesses one-year HbA1c as a predictor of subsequent pancreas graft survival. A retrospective cohort study was conducted using the UNOS registry...
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Frontiers Media S.A.
2025-08-01
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| Series: | Transplant International |
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| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14940/full |
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| author | Georgios Kourounis Georgios Kourounis Georgios Kourounis Samuel J. Tingle Samuel J. Tingle Samuel J. Tingle Angeles Maillo-Nieto Caroline Wroe Emily R. Thompson Emily R. Thompson Emily R. Thompson Ruth Owen Leonie van Leeuwen Matthew Holzner Vikram Wadhera Mohammed Zeeshan Akhtar Sander Florman James Shaw James Shaw James Shaw Steve White Steve White Colin Wilson Colin Wilson Colin Wilson |
| author_facet | Georgios Kourounis Georgios Kourounis Georgios Kourounis Samuel J. Tingle Samuel J. Tingle Samuel J. Tingle Angeles Maillo-Nieto Caroline Wroe Emily R. Thompson Emily R. Thompson Emily R. Thompson Ruth Owen Leonie van Leeuwen Matthew Holzner Vikram Wadhera Mohammed Zeeshan Akhtar Sander Florman James Shaw James Shaw James Shaw Steve White Steve White Colin Wilson Colin Wilson Colin Wilson |
| author_sort | Georgios Kourounis |
| collection | DOAJ |
| description | Understanding which factors shape long-term pancreas graft outcomes after the critical first year post-transplantation is an ongoing challenge. This study assesses one-year HbA1c as a predictor of subsequent pancreas graft survival. A retrospective cohort study was conducted using the UNOS registry on all simultaneous pancreas-kidney (SPK) transplants between 2017 and 2023. Regression models with multiple imputations for missing data were used to evaluate predictors of long-term function. Non-linear relationships were modelled with restricted cubic splines (RCS). Among 2,917 SPK recipients (median follow-up 44 months, IQR: 25–60), one-year HbA1c was the strongest independent predictor of long-term graft survival. An HbA1c of 6.8% versus 4.4% (95th vs. 5th percentile) was associated with significantly worse graft survival (aHR = 2.48, 95% CI: 1.72–3.58). Simulated trial sample size calculations found that detecting a statistically and clinically significant reduction in one-year HbA1c from 7% to 6.5% would require 65 patients per group, whereas detecting a reduction in one-year graft loss from 12% to 9% would require 1,631 patients per group. HbA1c at 1 year is a robust, continuous marker of long-term graft function and may serve as a feasible, objective surrogate endpoint in future clinical trials, enabling smaller, more efficient study designs to evaluate interventions. |
| format | Article |
| id | doaj-art-f9b002e1d63347e98d78a213ed1753d2 |
| institution | Kabale University |
| issn | 1432-2277 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj-art-f9b002e1d63347e98d78a213ed1753d22025-08-20T04:02:17ZengFrontiers Media S.A.Transplant International1432-22772025-08-013810.3389/ti.2025.1494014940One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort StudyGeorgios Kourounis0Georgios Kourounis1Georgios Kourounis2Samuel J. Tingle3Samuel J. Tingle4Samuel J. Tingle5Angeles Maillo-Nieto6Caroline Wroe7Emily R. Thompson8Emily R. Thompson9Emily R. Thompson10Ruth Owen11Leonie van Leeuwen12Matthew Holzner13Vikram Wadhera14Mohammed Zeeshan Akhtar15Sander Florman16James Shaw17James Shaw18James Shaw19Steve White20Steve White21Colin Wilson22Colin Wilson23Colin Wilson24Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomRecanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, United StatesRecanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, United StatesRecanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, United StatesRecanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, United StatesRecanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, NY, United StatesTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomTranslational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United KingdomNIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, United KingdomInstitute of Transplantation, The Freeman Hospital, Newcastle upon Tyne, United KingdomUnderstanding which factors shape long-term pancreas graft outcomes after the critical first year post-transplantation is an ongoing challenge. This study assesses one-year HbA1c as a predictor of subsequent pancreas graft survival. A retrospective cohort study was conducted using the UNOS registry on all simultaneous pancreas-kidney (SPK) transplants between 2017 and 2023. Regression models with multiple imputations for missing data were used to evaluate predictors of long-term function. Non-linear relationships were modelled with restricted cubic splines (RCS). Among 2,917 SPK recipients (median follow-up 44 months, IQR: 25–60), one-year HbA1c was the strongest independent predictor of long-term graft survival. An HbA1c of 6.8% versus 4.4% (95th vs. 5th percentile) was associated with significantly worse graft survival (aHR = 2.48, 95% CI: 1.72–3.58). Simulated trial sample size calculations found that detecting a statistically and clinically significant reduction in one-year HbA1c from 7% to 6.5% would require 65 patients per group, whereas detecting a reduction in one-year graft loss from 12% to 9% would require 1,631 patients per group. HbA1c at 1 year is a robust, continuous marker of long-term graft function and may serve as a feasible, objective surrogate endpoint in future clinical trials, enabling smaller, more efficient study designs to evaluate interventions.https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14940/fullpancreas transplantationsimultaneous pancreas-kidney transplantationglycosylated hemoglobin (HbA1c)graft survivallong-term outcomes |
| spellingShingle | Georgios Kourounis Georgios Kourounis Georgios Kourounis Samuel J. Tingle Samuel J. Tingle Samuel J. Tingle Angeles Maillo-Nieto Caroline Wroe Emily R. Thompson Emily R. Thompson Emily R. Thompson Ruth Owen Leonie van Leeuwen Matthew Holzner Vikram Wadhera Mohammed Zeeshan Akhtar Sander Florman James Shaw James Shaw James Shaw Steve White Steve White Colin Wilson Colin Wilson Colin Wilson One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study Transplant International pancreas transplantation simultaneous pancreas-kidney transplantation glycosylated hemoglobin (HbA1c) graft survival long-term outcomes |
| title | One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study |
| title_full | One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study |
| title_fullStr | One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study |
| title_full_unstemmed | One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study |
| title_short | One-Year HbA1c Predicts Long-Term Pancreas Graft Survival Following SPK Transplantation: A US Population Cohort Study |
| title_sort | one year hba1c predicts long term pancreas graft survival following spk transplantation a us population cohort study |
| topic | pancreas transplantation simultaneous pancreas-kidney transplantation glycosylated hemoglobin (HbA1c) graft survival long-term outcomes |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14940/full |
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