Decline in native renal function early after bladder-drained pancreas transplantation alone

Mazur, Marek; Rea, David; Griffin, Matthew D.; Larson, Timothy S.; Prieto, Mikel; Gloor, James M.; Schwab, Thomas R.; Textor, Stephen C.; Nyberg, Scott L.; Stegall, Mark D.

doi:10.1097/01.tp.0000114607.62534.c9

Cited by 39 publications

(33 citation statements)

References 15 publications

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“…4 An impact of PTA on the decreased kidney function was demonstrated by both direct measurement of GFR 5 and calculation methods, which have generally shown a good correlation. 5,6 Various factors seemed to have been involved in the impaired renal function post-PTA. Recipient age younger than 30 years and SCr Ͼ15 mg/L at the time of pancreas transplantation were associated with kidney failure in PTA recipients using a multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Native Kidney Function After Pancreas Transplantation Alone

Dinh

Deroover

Coimbra

et al. 2012

Transplantation Proceedings

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Introduction. This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. Patients and Methods. Ten of eighteen PTA patients bearing functioning grafts for at least 1 year were recruited for the analysis. Primary endpoints were changes in mean serum creatinine (SCr, mg/L) and mean estimated glomerular filtration rate (eGFR) using the 4-variable Levey-MDRD equation (mL/min/1.73 m 2 ) comparing baseline (pretransplantation) to 6-month, 1-year, 3-year, and 5-year posttransplantation values. Mean follow-up time was 75.7 Ϯ 20.5 months (range, 46 -106.5). Results. Baseline eGFR was 89.3 Ϯ 27.9 (range, 58 -145). eGFR decreased to 75.7 Ϯ 26.2, 71 Ϯ 20.6, 66.5 Ϯ 14.8, and 62.1 Ϯ 11.2 at 6 months, 1, 3, and 5 years representing Ϫ15.2%, Ϫ20.5%, Ϫ15.8%, and Ϫ22.6% percentage decreases respectively (P Ͻ .05 for all pairwise comparisons). The Baseline SCr was 8.6 Ϯ 2.3 mg/L (range, 5-13). SCr progressively increased to 10.1 Ϯ 3, 10.5 Ϯ 3.1, 10.9 Ϯ 3.1, and 11.3 Ϯ 1.7 at 6 months, 1, 3, and 5 years a 17.1%, 22%, 16.6%, and 19.9% increase respectively (P Ͻ .05 for all pairwise comparisons). One of ten, 2/8, and 3/7 patients displayed an eGFR Ͻ60 at transplantation versus 3 and 5 years thereafter, respectively. No patient developed a SCr Ͼ 25 mg/L or eGFR Ͻ30 or needed dialysis or kidney transplantation. Five of ten patients had micro-albuminuria or proteinuria before transplantation. Tacrolimus levels were within recommended therapeutic ranges over time. Conclusion. Kidney function deteriorated significantly after PTA. Understanding of risk factors for the development of renal impairment is important to preserve kidney function and to select appropriate candidates for PTA.

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Section: Discussionmentioning

confidence: 99%

Evolution of Native Kidney Function After Pancreas Transplantation Alone

Dinh

Deroover

Coimbra

et al. 2012

Transplantation Proceedings

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“…(55) seguiu 97 pacientes submetidos ao TIP e notou que aqueles com clearance creatinina inferior a 55 ml/minuto evoluíram para doença renal terminal, mostrando a importância da seleção rigorosa dos candidatos a este procedimento. Assim, as evidências médicas atuais não suportam a indicação de um TIP para a prevenção da nefropatia diabética, já que a nefrotoxicidade dos imunossupressores, talvez associados à contração de volume em virtude da drenagem vesical, bem como da acidose metabólica, podem a longo prazo comprometer a função renal, que parece ser mais rápida quanto pior é a função renal pré-transplante (56).…”

Section: Sá Et Alunclassified

Transplante de pâncreas e ilhotas em portadores de diabetes melito

Sá

Gonzalez

Melaragno

et al. 2008

Arq Bras Endocrinol Metab

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O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

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“…The beneficial effects were evident despite the nephrotoxic effects of immunosuppressive agents. On the other hand, Mazur et al (50) investigated the renal function in 23 patients after pancreas transplantation and showed a decline in the native renal function in the majority of patients regardless of the pre-transplant glomerular filtration rates.…”

Section: Does Pancreas Transplantation Alone Reverse Diabetic Nephropmentioning

confidence: 99%

An Evidence‐Based Analysis of Simultaneous Pancreas‐Kidney and Pancreas Transplantation Alone

Demartines

Schiesser

Clavien

2005

American Journal of Transplantation

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While pancreas transplantation has evolved within two decades from a frustrating and poorly-accepted therapeutic option to a highly successful procedure, the respective benefits of the successive surgical and immunosuppressive developments have remained unclear. The aim of this study was to determine using an evidence-based methodology, which novel approaches have contributed to the current results and whether pancreas transplantation is cost-effective. Out of 2481 articles, 102 analyzed either surgical or immunosuppressive aspects of pancreas transplantation. Urological complications were more frequent in bladder over enteric drainage (range: 62-63% vs. 12-20%, p = 0.0001), but without significant difference in patient or graft survival. Portal drainage was associated with a trend toward fewer complications and better hyperinsulinemia control over systemic drainage in retrospective studies. Immunosuppression combining induction therapy, a calcineurin inhibitor, mycophenolate mophetil (MMF) and corticosteroids were associated with a 40% decreased incidence of rejection (p = 0.01) and an increase in graft survival above 90% at 1 year (p < 0.05). Pancreas transplantation is highly cost-effective compared to conservative alternatives. We conclude that despite a paucity of large studies, enteric drainage should be recommended but the benefits of portal venous drainage remain debated. Quadruple immunosuppression protocols including induction therapy should be the standard regimen.

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Decline in native renal function early after bladder-drained pancreas transplantation alone

Abstract: Bladder-drained PTA results in a decline in native renal function in the majority of patients regardless of the pretransplant GFR. These data suggest the need for strategies to prevent or minimize the decline in renal function after PTA.

Cited by 39 publications

References 15 publications

Evolution of Native Kidney Function After Pancreas Transplantation Alone

Evolution of Native Kidney Function After Pancreas Transplantation Alone

Transplante de pâncreas e ilhotas em portadores de diabetes melito

An Evidence‐Based Analysis of Simultaneous Pancreas‐Kidney and Pancreas Transplantation Alone

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