title: Kidney function before pancreas transplant alone predicts subsequent risk of end-stage renal disease.
abstract: BACKGROUND
  Recipients of a pancreas transplant alone (PTA) have varying levels of kidney function at the time of transplantation, but the role of kidney function in predicting the risk of end-stage renal disease (ESRD) after PTA remains unclear.
  
  
  METHODS
  A study was conducted on 1,135 adult recipients of a first PTA from January 1, 1994 to December 31, 2009 in the Scientific Registry of Transplant Recipients. ESRD events were derived from the United States Renal Data System. Cox proportional hazards models were fitted to determine the independent association of the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration formula before PTA and ESRD. The continuous relation between eGFR and ESRD was modeled using fractional polynomial terms.
  
  
  RESULTS
  The cumulative probabilities of ESRD for eGFR ≥ 90, 60 to 89.9, and <60 mL/min/1.73 m(2) at 5 years were 3.5, 12.2, and 26.0%, and at 10 years were 21.8, 29.9, and 52.2%, respectively. Patients with eGFR <60 and 60 to 89.9 mL/min/1.73 m(2) were 7.74 (95% CI: 4.37, 13.74) and 3.25 (95% CI: 1.77, 5.97) times more likely to develop ESRD than patients with eGFR ≥ 90 mL/min/1.73 m(2). The fractional polynomial model showed a log-linear relation between eGFR and the hazard ratio for ESRD. The results were robust to several sensitivity analyses.
  
  
  CONCLUSIONS
  Kidney function before PTA is a strong independent predictor of ESRD. These results may inform patient selection and the use of targeted interventions to reduce the risk of progressive kidney impairment in this patient population.
authors.affiliation: 1 Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada. 2 Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4 Department of Medicine, Multi-Organ Transplant Program, McGill University Health Center, McGill University, Montreal, Quebec, Canada. 5 Department of Surgery, Multi-Organ Transplant Program, McGill University Health Center, McGill University, Montreal, Quebec, Canada. 6 Address correspondence to: S. Joseph Kim, M.D., Ph.D., M.H.S., F.R.C.P.C., Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11C-1183, Toronto, Ontario, Canada M5G 2N2.
authors.forename: Sang Joseph
authors.initials: SJ
authors.lastname: Kim
authors.forename: Nassima
authors.initials: N
authors.lastname: Smail
authors.forename: Steven
authors.initials: S
authors.lastname: Paraskevas
authors.forename: Jeffery
authors.initials: J
authors.lastname: Schiff
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007677:Kidney Function Tests; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States