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Decline in native renal function early after bladder-drained pancreas transplantation alone
Marek J Mazur1, David J Rea, Matthew D Griffin
1Department of Internal Medicine, Division of Nephrology, Mayo Clinic, Rochester, MN 55905, USA.
Transplantation
|April 13, 2004
Summary
Pancreas transplant alone (PTA) often leads to decreased kidney function in most patients within the first year. This decline in native renal function occurs regardless of initial kidney health, highlighting a need for protective strategies.
Area of Science:
- Nephrology
- Transplantation Immunology
- Endocrinology
Background:
- Pancreas transplant alone (PTA) is an established therapy for select nonuremic patients with type 1 diabetes mellitus.
- A significant concern with PTA is the potential for complications, particularly a decline in native renal function.
- This study investigates the impact of PTA on kidney function over the first year post-transplant.
Purpose of the Study:
- To examine trends in native renal function during the first posttransplant year in PTA recipients.
- To assess the effect of pretransplant glomerular filtration rates (GFR) on renal function changes after PTA.
- To identify the prevalence and extent of renal function decline following PTA.
Main Methods:
- Retrospective analysis of 23 bladder-drained PTA recipients transplanted between April 1998 and September 2001.
- Measured GFR using corrected iothalamate clearance at pre-transplant evaluation and 1 year post-transplant.
- Calculated creatinine clearance at multiple time points: pre-transplant evaluation, day of transplant, and 1, 6, and 12 months post-transplant.
Main Results:
- A significant decline in mean measured GFR was observed, decreasing from 84 +/- 33 mL/min/1.73 m2 pre-transplant to 52 +/- 26 mL/min/1.73 m2 at 1 year (P <0.001).
- 96% of patients (22 of 23) experienced a decrease in iothalamate clearance within the first year.
- While most patients showed declining renal function, some, including those with lower baseline GFR, maintained stable kidney function; however, one patient required a kidney transplant due to renal failure.
Conclusions:
- Bladder-drained PTA is associated with a decline in native renal function in the majority of recipients, irrespective of their pre-transplant GFR.
- The findings underscore the necessity for developing and implementing strategies to prevent or mitigate renal function deterioration after PTA.
- Further research is warranted to explore interventions that preserve kidney function in pancreas transplant recipients.