Risk analysis for deterioration of renal function after pancreas alone transplant
Chatzizacharias NA., Vaidya A., Sinha S., Sharples E., Smith R., Jones G., Brockmann J., Friend PJ.
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) <70mL/min/1.73m2. 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 (>12mg/dL) at sixmonths 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 ≥100mg/mmol) marginally failed to reach significance (p=0.056). Low eGFR levels alone (≤45 and ≤40mL/min/1.73m2) 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. © 2012 John Wiley & Sons A/S.