Impact of pancreas transplantation alone on kidney function: A multicenter clinical cohort study.

Autor: Kaur RJ; Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic Rochester, Rochester, Minnesota, USA., Mujtahedi SS; Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota, USA., Fridell JA; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA., Benavides X; Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota, USA., Smith B; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA., Larson TS; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Rizvi SR; Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic Rochester, Rochester, Minnesota, USA., Kukla A; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA., Dean P; Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota, USA., Kudva YC; Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic Rochester, Rochester, Minnesota, USA., Odorico J; Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, UWHealth Transplant Center, Madison, Wisconsin, USA., Stegall M; Department of Surgery and Immunology, Mayo Clinic, Rochester, Minnesota, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Jan; Vol. 38 (1), pp. e15212. Date of Electronic Publication: 2023 Dec 01.
DOI: 10.1111/ctr.15212
Abstrakt: Pancreas transplantation alone (PTA) is a β cell replacement option for selected patients with type 1 diabetes mellitus; concerns have been raised regarding deterioration in kidney function (KF) after PTA. This retrospective multicenter study assessed actual impact of transplantation and immunosuppression on KF in PTA recipients at three Transplant Centers. The primary composite endpoint 10 years after PTA was >50% eGFR decline, eGFR < 30 mL/min/1.73 m 2 , and/or receiving a kidney transplant (KT). Overall, 822 PTA recipients met eligibility. Median baseline and 10-year eGFR (mL/min/1.73 m 2 ) were 76.3 (58.1-100.8) and 51.3 (35.3-65.9), respectively. Primary composite endpoint occurred in 98 patients (53.5%) with 45 experiencing a >50% decrease in eGFR by 10 years post-transplant, 38 eGFR < 30 mL/min/1.73 m 2 and 49 requiring KT. KF declined most significantly within 6 months post-PTA, more often in females and patients with better preserved GFR up to 5 years with 11.6% kidney failure at 10 years. Patient survival and death-censored graft survival were both 68% at 10 years with overall graft thrombosis rate 8%. KF declined initially after PTA but stabilized with further slow progression. In conclusion, prospective intervention studies are needed to test renal sparing interventions while gathering more granular data.
(© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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