title: Risk analysis for deterioration of renal function after pancreas alone transplant.
abstract: The risk of progression to renal replacement after pancreas transplant alone (PTA) is a concern in patients with pre-transplant estimated glomerular filtration rate (eGFR) < 70 mL/min/1.73 m(2). This is a retrospective, single-center risk analysis of potential factors affecting renal function after PTA. Twenty-four patients, transplanted over a three-yr period, with functioning pancreatic grafts at the study's end point were included. High tacrolimus levels (> 12 mg/dL) at six months post-transplant was the only independent risk factor identifying a substantial decline in native renal function by Cox regression analysis (HR = 14.300, CI = 1.271-160.907, p = 0.031). The presence of severe pre-transplant proteinuria (urine Pr/Cr ≥ 100 mg/mmol) marginally failed to reach significance (p = 0.056). Low eGFR levels alone (≤ 45 and ≤ 40 mL/min/1.73 m(2)) at the time of transplant did not correlate with substantial decline in renal function. Our data suggest that PTA is a justifiable therapy for patients with hypoglycemia unawareness or other life-threatening diabetic complications, even in those with borderline renal function, provided that they do not suffer from severe proteinuria and appropriate monitoring and tailoring of immunosuppression is ensured.
authors: Oxford Transplant Centre, Churchill Hospital, Oxford, UK.
authors: Nikolaos A
authors: NA
authors: Chatzizacharias
authors: Anil
authors: A
authors: Vaidya
authors: Sanjay
authors: S
authors: Sinha
authors: Edward
authors: E
authors: Sharples
authors: Richard
authors: R
authors: Smith
authors: Gareth
authors: G
authors: Jones
authors: Jens
authors: J
authors: Brockmann
authors: Peter J
authors: PJ
authors: Friend
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000401:mortality*; D011379:Prognosis; D051437:Renal Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate