Kidney disease in non-kidney solid organ transplantation

Table 1 Kidney disease after pancreas transplant alone

Ref.	Total number of patients, n	Risk factors associated with kidney disease	Study conclusion
Kim et al[6]	1135	Pre-transplant eGFR < 60 mL/min/1.73 m2. Pre-transplant eGFR 60-89.9 mL/min/1.73 m2	PTA recipients with pre-transplant eGFR < 60 and 60-89.9 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 ESKD than patients with eGFR ≥ 90 mL/min/1.73 m2
Smail et al[18]	43	Pre-transplant eGFR < 60mL/min/1.73m2 was associated with a ESRD incidence at 1, 3, 5 yr of 0, 28.6% and 61.9% compared to those with an eGFR > 60 mL/min/1.73 m2 1, 3, 5 yr incidence of 0.82, and 12.5% (P = 0.006); age, female sex, duration of diabetes pre-PTA (all P < 0.05)	The risk of progression to ESRD after PTA may be increased in patients with pretransplant eGFR below 60 mL/min/1.73 m2, younger patients and in women
Gruessner et al[19]	513	SCr > 1.5 mg/dL at transplant, age < 30	5 yr post-transplant ESKD rate of 13%
Odorico et al[20]	27 PTA, 61 PAK	Pre-transplant eGFR < 60 mL/min/1.73 m2	67% PTA patients showed an increase (> 10%) in their SCr from baseline vs 34% PAK patients (P = 0.035). PTA transplant was considered mildly renoprotective; this finding was not significant (HR = 0.29, 95%CI: 0.04-2.37, P = 0.182)
Chatzizacharias et al[21]	24	Tacrolimus levels > 12 mg/dL at 6 mo post-transplant	Tacrolimus levels, but not pre-transplant proteinuria or low eGFR < 45 mL/min/1.73 m2 were associated with CKD progression
Marchetti et al[22]	28		Stable native kidney function comparing pre-transplant to post-transplant (0.95 ± 0.2 vs 0.96 ± 0.22, P > 0.05); limited follow up of 3 mo
Coppelli et al[17]	32		32 PTA recipients did not have significantly different creatinine pre-and post-transplant (0.95 ± 0.25 mg/dL vs 1.00 ± 0.19 mg/dL, P > 0.05); PTA lead to improvement in lipids, BP, and albuminuria
Genzini et al[23]	45; 20-group 1 CrCl ≤ 70 mL/min; 25-group 2 CrCl > 70 mL/min	CrCl < 70 mL/min	Kidney function at 1-yr: Group 1 CrCl pre- vs post-transplantation = 57.3 ± 9 vs 34.8 ± 32 mL/min, P = 0.003); (group 2 CrCl pre- vs post-transplantation = 107.1 ± 25 vs 81.0 ± 23 mL/min, P = 0.008). In group 1, 10/20 patients (50%) ended up with a CrCl < 30 mL/min, 5/20 (25%) initiated on hemodialysis, and 3/20 (15%) underwent kidney after pancreas transplantation. No patients in group 2 ended up with significantly decreased kidney function
Scalea et al[24]	123		88% of patients had eGFR decrease with a mean decrement of 32.1 mg/min/1.73 m2. Mean eGFR pre-transplantation was 88.9 vs 55.6 post-transplantation (P < 0.0001) with mean follow-up of 3.68 yr. Donor demographics, immunosuppression, HLA mismatch were not significantly associated with progressive CKD in their analysis

PTA: Pancreas transplant alone; ESKD: End stage kidney disease; eGFR: Estimated glomerular filtration rate; ESRD: End stage renal disease; SCr: Serum creatinine; PAK: Pancreas after kidney transplant; HR: Hazard ratio; CI: Confidence interval; BP: Blood pressure; CrCl: Creatinine clearance; HLA: Human leukocyte antigen; CKD: Chronic kidney disease.