Kidney Function Before Pancreas Transplant Alone Predicts Subsequent Risk of End-Stage Renal Disease

Abstract

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.

First World Consensus Conference on pancreas transplantation: Part II – recommendations

“…On practical grounds, in pancreas transplantation, there are still many issues for which practice is not strongly supported by evidence, despite excellent clinical results. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 …”

“…One study reports the deceleration of retinal damage early after PTA, with potential stabilization over time. 26 , 78 , 80 Experts acknowledged that successful PTA contributes to stabilization/improvement of diabetic retinopathy.…”

“…Some data show that in patients with a functioning PTA and not evolving toward chronic kidney disease, the decrease in eGFR over time is similar to that observed in the general T1D population. 26 , 27 , 76 Experts acknowledged that functioning PTA improves the evolution of diabetic nephropathy, but underscored as these beneficial effects may be sometimes offset by CNI‐related nephropathy.…”

“… 18 , 19 , 20 Although the reasons for this decline are multifactorial, the lack of objective assessment of the impact of pancreas transplantation on the treatment of diabetic patients and absence of validated practice guidelines may be among the contributing factors. In selected patients, pancreas transplantation provides dramatic improvements in quality of life 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 and may prolong survival. 33 , 34 , 35 , 36 , 37 , 38 , 39 Additionally, some traditional deterrents have been minimized because pancreas transplantation currently requires the same immunosuppression as kidney transplantation 40 and surgical complications are observed at lower rates.…”

Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function

“…Posttransplant ESRD was found to be associated with a higher level of calcineurin inhibitor at six months posttransplant. It has been reported that a lower preoperative eGFR was associated with a greater likelihood of progression to clinically significant kidney disease [ 22 – 24 ]. Of note, even though a preoperative eGFR was more than 90mL/min/1.73 m 2 , there was a considerable risk of native kidney failure after PTA in our analysis.…”