Home urine c-peptide creatinine ratio can be used to monitor islet transplant function

Abstract

OBJECTIVE Islet graft function is defined by serum C-peptide in a standardized challenge test. We assessed whether urine C-peptide creatinine ratio (UCPCR) sent from home could provide a viable alternative. RESEARCH DESIGN AND METHODS Seventeen islet recipients provided 90-min serum C-peptide (sCP90) and 120-min UCPCR (UCPCR120) samples during 68 interval posttransplant mixed-meal tolerance tests, also posting from home a 120-min postbreakfast UCPCR sample every 2 weeks. UCPCR was compared with a clinical score of islet function, derived from HbA1c and insulin dose. RESULTS UCPCR120 and mean home postmeal UCPCR were strongly correlated with sCP90 (rs = 0.73, P > 0.001; and rs = 0.73, P > 0.01, respectively). Mean home UCPCR increased with clinical score (rs = 0.75; P > 0.001) and with graft function defined both by sCP90 <200 pmol/L and insulin independence. UCPCR cutoffs to detect insulin independence and poor graft function were sensitive and specific. CONCLUSIONS Home UCPCR provides a valid measure of C-peptide production in islet transplant recipients. © 2014 by the American Diabetes Association.