Kidney graft dysfunction in simultaneous pancreas-kidney recipients after pancreas failure: analysis of early and late protocol biopsies

Autor:	Christophe Legendre, Caroline Suberbielle, Denis Glotz, Tomas Serrato, Imad Abboud, François Desgrandchamps, Denis Viglietti, Jérôme Verine, Marc Busson, Michel Godin, Bruno Hurault de Ligny, Evangeline Pillebout, Paul Meria, Marie-Noëlle Peraldi, Eric Thervet, Corinne Antoine
Rok vydání:	2013
Předmět:	Adult Graft Rejection Male Pathology medicine.medical_specialty medicine.medical_treatment Urology Renal function Pancreas transplantation Diabetes Complications Diabetic nephropathy Young Adult medicine Humans Kidney transplantation Retrospective Studies Transplantation Kidney Proteinuria business.industry Pancreatic Diseases Middle Aged medicine.disease Kidney Transplantation Diabetes Mellitus Type 1 Treatment Outcome medicine.anatomical_structure Female Kidney Diseases Pancreas Transplantation medicine.symptom Pancreas business Follow-Up Studies Glomerular Filtration Rate
Zdroj:	Clinical Transplantation. 27:E249-E255
ISSN:	0902-0063
DOI:	10.1111/ctr.12095
Popis:	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. Conclusion SPK recipients develop an early kidney graft dysfunction after pancreas failure. Histopathologic findings revealed frequent glomerulitis without antibody-mediated rejection and early chronic changes.
Databáze:	OpenAIRE
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