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

Pancreas transplant alone (PTA) patients may progress to develop advanced chronic kidney disease (CKD). This study seeks to identify pretransplant factors among PTA recipients that predict progression to advanced CKD.

All primary PTA transplanted at our center >22 y were included if they had >2 wk of pancreas graft survival. Recipients were categorized as having advanced CKD if they reached the need for dialysis or kidney transplant or developed an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 or spot urine-protein creatine ratio >1 gm/gm and associated risk factors were evaluated. All eGFR was recalculated utilizing the race-neutral serum creatinine-based eGFR calculator through the National Kidney Foundation eGFR calculator.

One hundred seventy-nine PTA recipients were included; 24 (13%) developed advanced CKD. Pretransplant eGFR was 79.8 mL/min/1.73 m 2 among the advanced CKD group compared with 98.4 in nonadvanced CKD group ( P  < 0.01). Of these, 14 initiated dialysis or received a kidney transplant, 8 reached an eGFR <30 mL/min/1.73 m 2 , and 2 developed new proteinuria. eGFR <80 mL/min/1.73 m 2 was associated with an increased risk of developing advanced CKD( P  = 0.002). In multivariate analysis, factors associated with increased risk for advanced CKD were older recipient age (hazard ratio [HR], 1.04; P  = 0.048) and donor with hypertension (HR, 2.63; P  = 0.046). Conversely, higher recipient body mass index (HR, 0.84; P  = 0.006) and higher pretransplant eGFR (HR, 0.97; P  = 0.03) were protective.

Important recipient and donor factors predicted a higher risk of developing advanced CKD in PTA recipients. These findings may help guide the selection of donors and recipients to minimize the risk of developing CKD in this population.