Risk Factors for Developing Advanced Chronic Kidney Disease in Pancreas Transplant Alone Recipients

Area of Science:

• Nephrology
• Transplantation Immunology
• Clinical Medicine

Background:

• Pancreas transplant alone (PTA) recipients are at risk for developing advanced chronic kidney disease (CKD).
• Identifying pretransplant predictors of CKD progression is crucial for patient management.

Purpose of the Study:

• To identify pretransplant factors in PTA recipients that predict the progression to advanced CKD.
• To inform donor and recipient selection strategies to mitigate CKD risk.

Main Methods:

• Retrospective analysis of primary PTA recipients with over 2 weeks of graft survival.
• Advanced CKD defined by need for dialysis, kidney transplant, eGFR <30 mL/min/1.73 m², or proteinuria.
• Utilized race-neutral NKF eGFR calculator for all calculations.

Main Results:

• 13% (24/179) of PTA recipients developed advanced CKD.
• Lower pretransplant eGFR (<80 mL/min/1.73 m²) was associated with increased CKD risk (P=0.002).
• Older recipient age (HR 1.04) and donor hypertension (HR 2.63) increased advanced CKD risk; higher recipient BMI (HR 0.84) and pretransplant eGFR (HR 0.97) were protective.

Conclusions:

• Pretransplant recipient age, donor hypertension, recipient BMI, and pretransplant eGFR are significant predictors of advanced CKD in PTA recipients.
• These factors can guide clinical decision-making in donor-recipient matching.
• Further research may refine risk stratification for CKD development post-pancreas transplantation.