Kidney Function Before Pancreas Transplant Alone Predicts Subsequent Risk of End-Stage Renal Disease

Abstract

Background Recipients of a pancreas transplant alone (PTA) have varying levels of kidney function at the time of transplantation, but the role of kidney function in predicting the risk of end-stage renal disease (ESRD) after PTA remains unclear. Methods A study was conducted on 1,135 adult recipients of a first PTA from January 1, 1994 to December 31, 2009 in the Scientific Registry of Transplant Recipients. ESRD events were derived from the United States Renal Data System. Cox proportional hazards models were fitted to determine the independent association of the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration formula before PTA and ESRD. The continuous relation between eGFR and ESRD was modeled using fractional polynomial terms. Results The cumulative probabilities of ESRD for eGFR ≥90, 60 to 89.9, and <60 mL/min/1.73 m2 at 5 years were 3.5, 12.2, and 26.0%, and at 10 years were 21.8, 29.9, and 52.2%, respectively. Patients with eGFR <60 and 60 to 89.9 mL/min/1.73 m2 were 7.74 (95% CI: 4.37, 13.74) and 3.25 (95% CI: 1.77, 5.97) times more likely to develop ESRD than patients with eGFR ≥90 mL/min/1.73 m2. The fractional polynomial model showed a log-linear relation between eGFR and the hazard ratio for ESRD. The results were robust to several sensitivity analyses. Conclusions Kidney function before PTA is a strong independent predictor of ESRD. These results may inform patient selection and the use of targeted interventions to reduce the risk of progressive kidney impairment in this patient population.