title: Kidney graft dysfunction in simultaneous pancreas-kidney recipients after pancreas failure: analysis of early and late protocol biopsies.
abstract: BACKGROUND
  Kidney graft survival in simultaneous pancreas-kidney (SPK) recipients is known to decrease after pancreas graft failure.
  
  
  METHODS
  Sixty-three consecutive SPK recipients were retrospectively reviewed. Kidney graft function and proteinuria were evaluated at three months after the transplantation and at last follow-up. Histopathologic findings of protocol biopsies performed three months and one yr after transplantation were analyzed.
  
  
  RESULTS
  Twelve patients lost the pancreas graft. Donors' characteristics were similar in patients with or without pancreas failure. After a median follow-up of 36 months, mean eGFR with a functional pancreas was 69.5 mL/min/1.73 m² vs. 56.3 mL/min/1.73 m² (p = 0.01) after pancreas loss. Patients who lost pancreas had a median proteinuria of 0.28 g vs. 0.13 g per 24 h (p = 0.02). Analysis of three-month protocol biopsies revealed more frequent isolated glomerulitis after pancreas failure (p = 0.0001), without peritubular capillaritis or C4d deposition. No donor-specific anti-HLA antibodies were detectable in these patients. Chronic tubulointerstitial changes were more frequent in patients with pancreas loss. There was no evidence of diabetic nephropathy recurrence.
  
  
  CONCLUSIONS
  SPK recipients develop an early kidney graft dysfunction after pancreas failure. Histopathologic findings revealed frequent glomerulitis without antibody-mediated rejection and early chronic changes.
authors: Service de Néphrologie et Transplantation, Hôpital Saint-Louis, Paris, France. denis.viglietti@wanadoo.fr
authors: Denis
authors: D
authors: Viglietti
authors: Tomas
authors: T
authors: Serrato
authors: Imad
authors: I
authors: Abboud
authors: Corinne
authors: C
authors: Antoine
authors: Evangéline
authors: E
authors: Pillebout
authors: Marc
authors: M
authors: Busson
authors: François
authors: F
authors: Desgrandchamps
authors: Paul
authors: P
authors: Meria
authors: Michel
authors: M
authors: Godin
authors: Bruno
authors: B
authors: Hurault de Ligny
authors: Eric
authors: E
authors: Thervet
authors: Christophe
authors: C
authors: Legendre
authors: Caroline
authors: C
authors: Suberbielle
authors: Jérome
authors: J
authors: Verine
authors: Denis
authors: D
authors: Glotz
authors: Marie-Noëlle
authors: MN
authors: Peraldi
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000209:etiology* / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult