Cargando…

Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function

BACKGROUND: Limited data are available regarding optimal selection criteria for pancreas transplant alone (PTA) to minimize aggravation of diabetic nephropathy. METHODS: A total of 87 type 1 diabetic patients were evaluated before and after PTA at a single center from January, 1999 to December, 2015...

Descripción completa

Detalles Bibliográficos
Autores principales: Shin, Sung, Jung, Chang Hee, Choi, Ji Yoon, Kwon, Hyun Wook, Jung, Joo Hee, Kim, Young Hoon, Han, Duck Jong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788334/
https://www.ncbi.nlm.nih.gov/pubmed/29377901
http://dx.doi.org/10.1371/journal.pone.0191421
_version_ 1783296068098719744
author Shin, Sung
Jung, Chang Hee
Choi, Ji Yoon
Kwon, Hyun Wook
Jung, Joo Hee
Kim, Young Hoon
Han, Duck Jong
author_facet Shin, Sung
Jung, Chang Hee
Choi, Ji Yoon
Kwon, Hyun Wook
Jung, Joo Hee
Kim, Young Hoon
Han, Duck Jong
author_sort Shin, Sung
collection PubMed
description BACKGROUND: Limited data are available regarding optimal selection criteria for pancreas transplant alone (PTA) to minimize aggravation of diabetic nephropathy. METHODS: A total of 87 type 1 diabetic patients were evaluated before and after PTA at a single center from January, 1999 to December, 2015, together with 87 matched non-transplanted type 1 diabetic subjects who were candidates for PTA to compare deterioration of native kidney function. A total of 163 patients (79 in the transplanted group and 84 in the nontransplanted group) were finally enrolled after excluding nine patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) and two patients with moderate proteinuria (≥ 1.5 g/day). RESULTS: A total of seven recipients (8.9%) had end-stage renal disease post-transplant whereas only one patient (1.2%) developed end-stage renal disease in the nontransplanted group during their follow-up period (median 12.0, range 6–96 months) (p = 0.03). Furthermore, a composite of severe renal dysfunction and end-stage renal disease (31.6% vs 2.4%) was significantly higher in the transplanted group (p < 0.001). Multivariate Cox regression analysis revealed that a higher level of tacrolimus at six months post-transplant (HR = 1.648, CI = 1.140–2.385, p = 0.008) was the only significant factor associated with end-stage renal disease. CONCLUSIONS: There is a considerable risk for deterioration of renal function in PTA recipients post-transplant compared with non-transplant diabetic patients. With rather strict selection criteria such as preoperative proteinuria and estimated glomerular filtration rate, PTA should be considered in diabetic patients to minimize post-transplant aggravation of diabetic nephropathy.
format Online
Article
Text
id pubmed-5788334
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-57883342018-02-09 Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function Shin, Sung Jung, Chang Hee Choi, Ji Yoon Kwon, Hyun Wook Jung, Joo Hee Kim, Young Hoon Han, Duck Jong PLoS One Research Article BACKGROUND: Limited data are available regarding optimal selection criteria for pancreas transplant alone (PTA) to minimize aggravation of diabetic nephropathy. METHODS: A total of 87 type 1 diabetic patients were evaluated before and after PTA at a single center from January, 1999 to December, 2015, together with 87 matched non-transplanted type 1 diabetic subjects who were candidates for PTA to compare deterioration of native kidney function. A total of 163 patients (79 in the transplanted group and 84 in the nontransplanted group) were finally enrolled after excluding nine patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) and two patients with moderate proteinuria (≥ 1.5 g/day). RESULTS: A total of seven recipients (8.9%) had end-stage renal disease post-transplant whereas only one patient (1.2%) developed end-stage renal disease in the nontransplanted group during their follow-up period (median 12.0, range 6–96 months) (p = 0.03). Furthermore, a composite of severe renal dysfunction and end-stage renal disease (31.6% vs 2.4%) was significantly higher in the transplanted group (p < 0.001). Multivariate Cox regression analysis revealed that a higher level of tacrolimus at six months post-transplant (HR = 1.648, CI = 1.140–2.385, p = 0.008) was the only significant factor associated with end-stage renal disease. CONCLUSIONS: There is a considerable risk for deterioration of renal function in PTA recipients post-transplant compared with non-transplant diabetic patients. With rather strict selection criteria such as preoperative proteinuria and estimated glomerular filtration rate, PTA should be considered in diabetic patients to minimize post-transplant aggravation of diabetic nephropathy. Public Library of Science 2018-01-29 /pmc/articles/PMC5788334/ /pubmed/29377901 http://dx.doi.org/10.1371/journal.pone.0191421 Text en © 2018 Shin et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Shin, Sung
Jung, Chang Hee
Choi, Ji Yoon
Kwon, Hyun Wook
Jung, Joo Hee
Kim, Young Hoon
Han, Duck Jong
Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title_full Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title_fullStr Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title_full_unstemmed Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title_short Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
title_sort long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788334/
https://www.ncbi.nlm.nih.gov/pubmed/29377901
http://dx.doi.org/10.1371/journal.pone.0191421
work_keys_str_mv AT shinsung longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT jungchanghee longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT choijiyoon longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT kwonhyunwook longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT jungjoohee longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT kimyounghoon longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction
AT handuckjong longtermeffectsofpancreastransplantaloneonnephropathyintype1diabeticpatientswithoptimalrenalfunction