title: Renal function in recipients of pancreas transplant alone.
abstract: OBJECTIVE
  Pancreas transplant alone (PTA) has become an accepted therapy for selected nonuremic patients with type 1 diabetes mellitus. We report a literature review, as well as data from the McGill University pancreas transplant program.
  
  
  RESULTS
  The published literature suggests that there is reversibility of diabetic nephropathy when normoglycemia is maintained for 5-10 years after successful PTA. There is also evidence of development and progression of histological lesions compatible with calcineurin inhibitor nephrotoxicity, as well as a decline in renal function overtime, with an increased risk of end-stage renal disease (ESRD). We studied 43 patients with PTA. Nine patients had a pretransplant estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m, and 34 patients had an eGFR greater than 60 ml/min/1.73 m. The actuarial incidence of ESRD at 1, 3 and 5 years was 0, 28.57 and 61.9% in patients with pretransplant eGFR less than 60 ml/min/1.73 m, and 0, 8.2 and 12.5% in patients with pretransplant eGFR greater than 60 ml/min/1.73 m, respectively (P=0.006). Multivariate analysis confirmed that age, sex, duration of diabetes prior to PTA and eGFR pretransplant were significant predictors of ESRD.
  
  
  CONCLUSIONS
  The ideal management of candidates for PTA with eGFR less than 60 ml/min/1.73 m remains to be determined. Future studies should focus on determining potentially reversible predictive factors of progression to ESRD after PTA, as well as the outcomes of these patients on chronic dialysis.
authors.affiliation: Department of Medicine, Research Institute, Multi-Organ Transplant Program, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Nassima
authors.initials: N
authors.lastname: Smail
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.forename: Xianming
authors.initials: X
authors.lastname: Tan
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
mesh_terms: D000328:Adult; D000367:Age Factors; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects; D011237:Predictive Value of Tests; D011792:Quebec / Q000453:epidemiology; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors