Influence of Pancreas Transplantation Alone on Native Renal Function (original) (raw)
Related papers
Kidney Function After Solitary Pancreas Transplantation
Transplantation Proceedings, 2008
Preserving kidney function in patients after solitary pancreas transplantation (SPTx) is an important consideration, yet various factors may negatively impact long-term function of the native kidneys or kidney allograft. To determine changes in kidney function over time in a series of patients receiving SPTx, we conducted a retrospective analysis and tracked changes in serum creatinine (SCr) and calculated glomerular filtration rate (GFR) from baseline to 6 months, 1 year, or 3 years after SPTx in a series of pancreas after kidney transplants PAK; (n ϭ 61) and pancreas transplants alone PTA; (n ϭ 27) performed at our institution. The mean follow-up for the PAK and PTA groups was 3.4 and 2.7 years, respectively. In this series, 8% of patients after SPTx developed significant kidney failure, defined by either initiation of dialysis or receiving a kidney transplant (PAK-6, PTA-1). Twenty seven percent of SPTx patients with a baseline GFR Ͻ 60 suffered either an elevated SCr Ͼ 2.2, dialysis, or kidney transplant, whereas no patients with a baseline GFR Ͼ 60 developed significant kidney dysfunction. In the PAK group, the GFR did not show significant deterioration over time. In contrast to relatively stable kidney function in PAK patients, PTA patients experienced overall significantly greater rates of decline over time. GFR in PTA patients decreased from 78 Ϯ 19 (40 to 114) mL/min/1.73 m 2 at baseline to 65 Ϯ 20 at 1 year (P ϭ .006), while SCr increased from 1.03 Ϯ 0.25 mg/dL to 1.28 Ϯ 0.43 over the same time period (P ϭ .012). These data show that kidney function may deteriorate after SPTx and proper patient selection may reduce the frequency of this complication.
Transplantation Journal, 2012
Background. Nephrotoxicity is a major complication with immunosuppression regimens used in transplantation. Calcineurin inhibitorYsparing or reduction regimens using sirolimus (SRL) have shown variable success in kidney transplantation. There is limited data on the role of SRL on native kidney function in pancreas transplantation. Methods. All patients undergoing pancreas transplantation from 2003 to 2010 were enrolled in this study (n=65). Patient demographic characteristics were identified and divided into two groups: those receiving tacrolimus (Tac) in combination with mycophenolate mofetil (MMF) and those maintained on a regimen of Tac and SRL with or without MMF. The slopes for estimated glomerular filtration rate (eGFR), serum creatinine level (sCr), and proteinuria changes over time were assessed between groups. Urine protein and creatinine ratio (uPr/uCr) was used to assess proteinuria. Results. There was no difference in baseline demographic characteristics. Patients were followed for a median of 3 years. Baseline sCr and eGFR were similar between groups. Differences in uPr/uCr and rate of change in sCr and eGFR were not significant between the groups overall or for any specific time. There was worsening of sCr, eGFR, and uPr/uCr within the groups over the period of study. There were no significant differences when groups were split by age or gender or when the SRL group was split further based on MMF inclusion. Conclusions. Our study findings suggest that using a Tac-SRL regimen in patients with pancreas alone transplantation is a safe approach and may not lead to worsening proteinuria and kidney function when compared with regimens using Tac with MMF.
Transplantation Direct, 2015
Background. There is some evidence pointing toward better renal function in kidney transplant recipients (KTR) treated with once-daily tacrolimus (QD-TAC) vs. twice-daily tacrolimus (BID-TAC). Methods. This is an extension study of a 1-year, single arm prospective study of stable KTR who were converted from BID-TAC to QD-TAC (4.9 ± 4.0 years after transplantation) in Spanish routine clinical practice. Patient and graft survival, renal function, acute rejection episodes, and other analytic parameters were assessed at 24 and 36 months after conversion. Results. A total of 1798 KTR were included in the extension study. Tacrolimus doses at 36 months were significantly lower compared to those at time of conversion (−0.2 mg/day; P = 0.023). Blood levels were lower than baseline during all the study (P < 0.001). Graft and patient survival at 3 years after conversion were 93.9% and 95.1%, respectively. Compared with baseline, the mean estimated glomerular filtration rate (eGFR) remained very stable at all timepoints (56.7 ± 19.8 vs 58.1 ± 24.6 mL/min per 1.73 m 2 at month 36; P = 0.623). Even when patients reinitiating dialysis were counted as eGFR = 0, the mean eGFR was very stable. In fact, a small but significant increase was observed at 36 months versus baseline (+0.1 mL/min per 1.73 m 2 ; P = 0.025). An increase in proteinuria was observed at 36 months versus baseline (+0.11 g/24 h; P < 0.001). Acute rejection rates were low during the study. Conclusions. Conversion from BID-TAC to QD-TAC in a large cohort of stable KTR was safe and associated with a very stable renal function after 3 years. Comparative studies are warranted to assess the feasibility of such conversion.
Evolution of Native Kidney Function After Pancreas Transplantation Alone
Transplantation Proceedings, 2012
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).
Transplantation Journal, 2004
Aims: After the first kidney transplantation performed by Murray in 1954, it has been considered as the best treatment choice for endstage renal disease around the world. However, in spite of the expertness of the procedure, improvement of new immunosuppressant drugs, and improvement of understanding about human immune system, rejection still is the dilemma of kidney transplantation. This study is designed to find the predictor for long-term renal allograft survival in episodes of rejection. Methods: We analyzed 239 recipient patients who experienced rejection among 1509 kidney transplantation cases done in Asan Medical Center between June 1990 and January 2004. Cases corresponded to simultaneous pancreas-kidney transplantation and immediate allograft removal hyperacute rejected transplant were excluded from the study. We paid attention to time of onset of rejection, HLA-DR matching, types of immunosuppressant regimen, amount of perioperative transfusion, serum creatinine level before and after the first attack of rejection, and reversibility of functional allograft survival rates. All the data were analyzed using SPSS software (Release 10.0, SPSS Inc., IL). Kaplan Meier method and Cox proportional hazards model were used for comparing the data. Results: 1) In a viewpoint of onset time of rejection (3, 6 month, 1 year after kidney transplantation), there was no statistical significance shown in renal allograft survival. 2) There were no statistically significant numbers of HLA-DR matching in renal allograft survival. 3) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 4) There was no statistical significance shown in renal allograft survival in the viewpoint of amount of perioperative transfusion. 5) There was no statistical significance shown in renal allograft survival in the viewpoint of immunosuppressant regimen. 6) There was statistical significance shown in renal allograft survival between groups of 1 day creatinine level after operation above and below 4.0(pϭ0.01). 7) DCr was defined as difference between highest and lowest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of DCr above and below 1.0(pϭ0.03). 8) DDCr was defined as difference between lowest creatinine level in the course of first rejection and baseline creatinine level primarily after kidney transplantation, and there was statistical significance shown in renal allograft survival between groups of DDCr, that is,-0.3ϳ0.3, 0.4ϳ0.6, 0.7ϳ1.0, 1.1ϳ1.5, more than 1.6, less than-0.4(pϭ0.0019). 9) rejCr was defined as highest creatinine level in the course of first rejection, and there was statistical significance shown in renal allograft survival between groups of rejCr above and below 3.0(pϭ0.0003). 10) There was statistic significance shown in renal allograft survival between groups of one month creatinine level after completion of rejection treatment above and below 1.7(pϭ0.046). 11) In multivariate analysis, DCr, rejCr, DDCr, one month creatinine level after completion of rejection treatment were found as statistically significant factors(pϭ0.027, 0.002, Ͻ0.0001, 0.023). Conclusions: Rejection after kidney transplantation has been known as major factor having a negative effect upon the renal allograft survival. As of occurrence of rejection, prediction of long-term renal allograft survival will be a great help to our decision making about treatment. At this point we suggest that DCr, DDCr of initial rejection episode is a great predictor on long-term renal allograft survival.
Transplantation, 2014
Background. Transplant patients on tacrolimus therapy exhibit a reduced glomerular filtration rate (GFR). The type of graft and immune treatment protocol may influence the extent and reversibility of this side effect. Methods. The present single-center study is conducted in 48 nonuremic type 1 diabetic recipients of an intraportal islet-cell graft under maintenance immunosuppression (IS) with tacrolimus and mycophenolate mofetil. Estimated GFR (eGFR) and albuminuria were followed up to 5 years posttransplantation. Results. Mean eGFR values decreased by 19 mL/min/1.73 m 2 after 1 to 2 weeks of IS (PG0.0001) and then remained stable throughout the complete treatment period. The decrease was related to predose trough tacrolimus concentrations or doses and disappeared upon its discontinuation; it was also associated with the presence of albuminuria at the time of transplantation. Tacrolimus treatment resulted in a reduction of albuminuria; its discontinuation restored albuminuria to the initial levels. Conclusions. The use of tacrolimus in our islet-cell transplant protocol caused an initial 20% reduction in eGFR, which was reversible following its discontinuation, at least within the 5-year follow-up period. The associated reduction in albuminuria was also reversible, compatible with a tacrolimus-induced preglomerular vasoconstriction. These observations support further use of our tacrolimus regimen in this patient population.
Tacrolimus Concentration/Dose Ratio: A Tool for Guiding Tacrolimus Dosage Post-renal Transplantation
Curēus, 2024
Background The calcineurin inhibitor, Tacrolimus (Tac), exhibits variable absorption and undergoes first-pass metabolism when administered orally. The narrow therapeutic window and individual variability of this immunosuppressive agent make therapeutic drug monitoring essential. We hypothesized that the Tac metabolism rate-defined as the blood concentration normalized by its daily dose (the C/D ratio)-is associated with post-renal transplant (RTx) function. Methodology A retrospective observational study was conducted including 40 RTx patients. Clinical reports from four follow-up ambulatory appointments at one, three, six, and 12 months were analyzed. Tac dose and its blood levels were used to calculate the Tac concentration/dose (C/D) ratio. Patients with a Tac C/D ratio <1.05 ng/mL x 1/mg and a C/D ratio >1.05 ng/mL x 1/mg were categorized as fast and slow metabolizers. Serum creatinine levels were compared between the two groups, and their association with the Tac C/D ratio was analyzed. Student's unpaired t-test and the Mann-Whitney U test were used to analyze the difference in the C/D ratio between the groups. Spearman correlation analysis was conducted to analyze the association of the C/D ratio with serum creatinine in both groups. A P-value of <0.05 was considered statistically significant. Results Fast metabolizers showed increased serum creatinine (P < 0.05), and the C/D ratio correlated with creatinine levels. ROC analysis used to identify fast metabolizers for the C/D ratio at three months had an area of 0.925 (P < 0.01). Conclusions The Tac C/D ratio can be used as an earlier diagnostic tool to predict the development of nephrotoxicity in RTx patients.
Tacrolimus (Pan Graf) as de Novo Therapy in Renal Transplant Recpients in India
Transplantation Proceedings, 2006
The safety and efficacy of tacrolimus in transplantation is well established. However, tacrolimus has only recently been available in India. We report an initial experience using tacrolimus as de novo therapy in a living related renal transplant program. Fifty-two consecutive recipients of living renal allografts were treated with tacrolimus, mycophenolate mofetil, or azathioprine and steroids. The dose of tacrolimus was adjusted to keep trough levels at 10 to 12 ng/mL in the first 3 months, 8 to 10 ng/mL in the next 3 months, and 5 to 8 ng/mL thereafter. Any evidence of graft dysfunction was evaluated by graft biopsy. The effect of this regimen on the lipid profile as well as the incidence of posttransplant diabetes mellitus was evaluated in an Indian population. All patients were followed for periods ranging from 6 to 72 weeks (mean ϭ 29 weeks). The incidence of acute rejection was 3.84%; 17.3% developed posttransplant diabetes mellitus. Graft and patient survivals at the current follow-up were 100% and 96.26%. In conclusion, tacrolimus is a safe and effective immunosuppressant in a living related renal transplant program.
Rastreamento da insuficiência renal crônica em usuários hipertensos e/ou diabéticos
Revista de Enfermagem UFPE on line, 2015
Objective: tracing chronic renal failure (CRF) in hypertensive and/or diabetic users. Method: a descriptive, cross-sectional, quantitative study, conducted with 169 records of patients registered in the Information System of Registration and Monitoring of Hypertensive and Diabetic-HIPERDIA. The study was approved by the Research Ethics Committee CAAE 02392912.1.0000.5208. Results: of the 169 users, 5,9% were diabetic, 63,9% hypertensive and 51 (30,1%) hypertensive/ diabetic. Among the hypertensive and/or diabetic users, mostly women with an average age of 55,5 years old. The body mass index was among overweight and obese (54,4%). The average systolic blood pressure was 128,93 ± 14,66 mmHg and diastolic blood pressure 81,23 ± 7,59 mmHg. Tracing the IRC presented cases in stages I, II and III. Conclusion: it is possible to trace the early IRC, within primary care, using the tools of daily practice. Descriptors: Chronic Renal Failure; Glomerular Filtration Rate; Hypertension; Diabetes Mellitus; Family Health Program. RESUMO Objetivo: rastrear a insuficiência renal crônica (IRC) em usuários hipertensos e/ou diabéticos. Método: estudo descritivo, transversal, quantitativo, realizado com 169 registros de pacientes cadastrados no Sistema Informatizado de Cadastramento e Acompanhamento de Hipertensos e Diabéticos-HIPERDIA. O estudo foi aprovado pelo Comitê de Ética em Pesquisa CAAE 02392912.1.0000.5208. Resultados: dos 169 usuários, 5,9% eram diabéticos, 63,9% hipertensos e 51 30,1% hipertensos e diabéticos. Dentre os usuários hipertensos e/ou diabéticos, a maioria mulheres com idade média de 55,5 anos. Apresentaram índice de massa corpórea entre sobrepeso e obeso (54,4%). A média da pressão arterial sistólica foi de 128,93 ± 14,66 mmHg e a da pressão arterial diastólica foi de 81,23 ± 7,59 mmHg. O rastreamento da IRC apresentou casos nos estágios I, II e III. Conclusão: é possível rastrear precocemente a IRC no âmbito da atenção básica utilizando-se dos instrumentos da prática diária.