Renal allograft failure predictors after PAK transplantation: results from the New England Collaborative Association of Pancreas Programs.
BACKGROUND
The reasons for kidney allograft failure subsequent to pancreas after kidney (PAK) are multifactorial; therefore, we examined these factors to identify a meaningful risk assessment that could assist in patient selection.


METHODS
Five transplant centers in New England collaborated for this multiinstitutional retrospective study of 126 PAK transplantation recipients who had a functioning pancreas allograft 7 days after transplantation. Host factors (age at pancreas transplant, gender, body weight, glomerular filtration rate at 3 months pre-PAK and at 3-, 6-, 9-, and 12-month post-PAK, presence of proteinuria, pre- or post-PAK kidney rejection, pancreas rejection, cytomegalovirus disease, and HbA1C at 6-month post-PAK) and transplant factors (time to PAK, use of induction antibody therapy, and combinations of immunosuppressive medications) were assessed in both univariate and multivariate analyses for the primary outcome of kidney allograft failure.


RESULTS
Of the variables assessed, factors associated with kidney allograft loss after PAK include impaired renal function in the 3 months before PAK, proteinuria, the occurrence of a post-PAK kidney rejection episode, and interval between kidney and pancreas transplantation more than 1 year.


CONCLUSIONS
In our analysis, post-PAK kidney allograft loss was strongly associated with glomerular filtration rate less than 45 mL/min pre-PAK, K to P interval of over 1 year, pre-PAK kidney rejection episode, and pre-PAK proteinuria. Diabetic candidates for PAK with any of these conditions should be counseled regarding the risk of post-PAK renal transplant failure.
Pavlakis
Martha
M
Department of Medicine, Division of Nephrology, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mpavlaki@bidmc.harvard.edu
Khwaja
Khalid
K
Mandelbrot
Didier
D
Tang
Hongying
H
Whiting
James W
JW
Lorber
Marc I
MI
Gautam
Amitabh
A
Johnson
Scott R
SR
Uknis
Marc E
ME
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001835:Body Weight; D003586:Cytomegalovirus Infections / Q000150:complications / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000378:metabolism; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000502:physiology*; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000175:diagnosis / Q000453:epidemiology; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D006442:Glycated Hemoglobin; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid