Stable renal function after islet transplantation: Importance of patient selection and aggressive clinical management

Cristiane B. Leitão, Pablo Cure, Shari Messinger, Antonello Pileggi, Oliver Lenz, Tatiana Froud, Raquel N. Faradji, Gennaro Selvaggi, Warren Kupin, Camillo Ricordi, Rodolfo Alejandro

Research output: Contribution to journalArticle

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Abstract

Background. Proteinuria development and decrease in glomerular filtration rate (GFR) have been observed after successful islet transplantation. The aim of this study was to determine clinical, laboratory, and immunosuppressant-related factors associated with kidney dysfunction in islet transplant recipients. Methods. A retrospective cohort study was conducted in 35 subjects submitted to pancreatic islet transplantation for treatment of unstable type 1 diabetes mellitus. Demographic, anthropometrical, and laboratory data, as well as immunosuppressive and antihypertensive therapy were recorded. Kidney function was assessed by albuminuria and estimated GFR (eGFR), calculated by modification of diet in renal disease formula. Results. Age was the only independent risk factor for low eGFR (<60 mL/min/1.73 m 2) (odds ratio [OR]=1.78 [1.22-2.61]). Low-density lipoprotein cholesterol (OR=2.90 [1.37-6.12]) and previous microalbuminuria (OR=6.42 [1.42-29.11]) were risk factors for transient macroalbuminuria. Interestingly, tacrolimus was a protective factor for macroalbuminuria (OR=0.12 [0.06-0.26]). Six of 30 (20%) normoalbuminuric subjects at baseline progressed to microalbuminuria. No subject developed sustained macroalbuminuria. Surprisingly, overall eGFR remained stable during follow-up (before transplant: 74.0±2.0; during immunosuppressive therapy: 75.4±2.8; and after withdrawal: 76.3±5.3 mL/min/1.73 m 2; P<0.05). Even subjects with low eGFR and microalbuminuria at baseline (n=10) maintained stable values posttransplantation (61.13±3.25 mL/min/1.73 m 2 vs. 63.32±4.36 mL/min/1.73 m 2, P=0.500). Conclusions. Kidney function remained stable after islet transplantation alone. The unchanged kidney function found in this sample may be attributed to healthier kidney status at baseline and possibly to prompt treatment of modifiable risk factors. Aggressive treatment of risk factors for nephropathy, such as blood pressure, low-density lipoprotein cholesterol, and careful tacrolimus levels monitorization, should be part of islet transplant recipient care.

Original languageEnglish
Pages (from-to)681-688
Number of pages8
JournalTransplantation
Volume87
Issue number5
DOIs
StatePublished - Mar 15 2009

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Islets of Langerhans Transplantation
Patient Selection
Kidney
Immunosuppressive Agents
Odds Ratio
Tacrolimus
Glomerular Filtration Rate
LDL Cholesterol
Diet Therapy
Therapeutics
Albuminuria
Type 1 Diabetes Mellitus
Proteinuria
Antihypertensive Agents
Cohort Studies
Retrospective Studies
Demography
Blood Pressure
Transplants

Keywords

  • Albuminuria
  • Blood pressure
  • Islet transplantation
  • Kidney function
  • Lipids

ASJC Scopus subject areas

  • Transplantation

Cite this

Stable renal function after islet transplantation : Importance of patient selection and aggressive clinical management. / Leitão, Cristiane B.; Cure, Pablo; Messinger, Shari; Pileggi, Antonello; Lenz, Oliver; Froud, Tatiana; Faradji, Raquel N.; Selvaggi, Gennaro; Kupin, Warren; Ricordi, Camillo; Alejandro, Rodolfo.

In: Transplantation, Vol. 87, No. 5, 15.03.2009, p. 681-688.

Research output: Contribution to journalArticle

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abstract = "Background. Proteinuria development and decrease in glomerular filtration rate (GFR) have been observed after successful islet transplantation. The aim of this study was to determine clinical, laboratory, and immunosuppressant-related factors associated with kidney dysfunction in islet transplant recipients. Methods. A retrospective cohort study was conducted in 35 subjects submitted to pancreatic islet transplantation for treatment of unstable type 1 diabetes mellitus. Demographic, anthropometrical, and laboratory data, as well as immunosuppressive and antihypertensive therapy were recorded. Kidney function was assessed by albuminuria and estimated GFR (eGFR), calculated by modification of diet in renal disease formula. Results. Age was the only independent risk factor for low eGFR (<60 mL/min/1.73 m 2) (odds ratio [OR]=1.78 [1.22-2.61]). Low-density lipoprotein cholesterol (OR=2.90 [1.37-6.12]) and previous microalbuminuria (OR=6.42 [1.42-29.11]) were risk factors for transient macroalbuminuria. Interestingly, tacrolimus was a protective factor for macroalbuminuria (OR=0.12 [0.06-0.26]). Six of 30 (20{\%}) normoalbuminuric subjects at baseline progressed to microalbuminuria. No subject developed sustained macroalbuminuria. Surprisingly, overall eGFR remained stable during follow-up (before transplant: 74.0±2.0; during immunosuppressive therapy: 75.4±2.8; and after withdrawal: 76.3±5.3 mL/min/1.73 m 2; P<0.05). Even subjects with low eGFR and microalbuminuria at baseline (n=10) maintained stable values posttransplantation (61.13±3.25 mL/min/1.73 m 2 vs. 63.32±4.36 mL/min/1.73 m 2, P=0.500). Conclusions. Kidney function remained stable after islet transplantation alone. The unchanged kidney function found in this sample may be attributed to healthier kidney status at baseline and possibly to prompt treatment of modifiable risk factors. Aggressive treatment of risk factors for nephropathy, such as blood pressure, low-density lipoprotein cholesterol, and careful tacrolimus levels monitorization, should be part of islet transplant recipient care.",
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T2 - Importance of patient selection and aggressive clinical management

AU - Leitão, Cristiane B.

AU - Cure, Pablo

AU - Messinger, Shari

AU - Pileggi, Antonello

AU - Lenz, Oliver

AU - Froud, Tatiana

AU - Faradji, Raquel N.

AU - Selvaggi, Gennaro

AU - Kupin, Warren

AU - Ricordi, Camillo

AU - Alejandro, Rodolfo

PY - 2009/3/15

Y1 - 2009/3/15

N2 - Background. Proteinuria development and decrease in glomerular filtration rate (GFR) have been observed after successful islet transplantation. The aim of this study was to determine clinical, laboratory, and immunosuppressant-related factors associated with kidney dysfunction in islet transplant recipients. Methods. A retrospective cohort study was conducted in 35 subjects submitted to pancreatic islet transplantation for treatment of unstable type 1 diabetes mellitus. Demographic, anthropometrical, and laboratory data, as well as immunosuppressive and antihypertensive therapy were recorded. Kidney function was assessed by albuminuria and estimated GFR (eGFR), calculated by modification of diet in renal disease formula. Results. Age was the only independent risk factor for low eGFR (<60 mL/min/1.73 m 2) (odds ratio [OR]=1.78 [1.22-2.61]). Low-density lipoprotein cholesterol (OR=2.90 [1.37-6.12]) and previous microalbuminuria (OR=6.42 [1.42-29.11]) were risk factors for transient macroalbuminuria. Interestingly, tacrolimus was a protective factor for macroalbuminuria (OR=0.12 [0.06-0.26]). Six of 30 (20%) normoalbuminuric subjects at baseline progressed to microalbuminuria. No subject developed sustained macroalbuminuria. Surprisingly, overall eGFR remained stable during follow-up (before transplant: 74.0±2.0; during immunosuppressive therapy: 75.4±2.8; and after withdrawal: 76.3±5.3 mL/min/1.73 m 2; P<0.05). Even subjects with low eGFR and microalbuminuria at baseline (n=10) maintained stable values posttransplantation (61.13±3.25 mL/min/1.73 m 2 vs. 63.32±4.36 mL/min/1.73 m 2, P=0.500). Conclusions. Kidney function remained stable after islet transplantation alone. The unchanged kidney function found in this sample may be attributed to healthier kidney status at baseline and possibly to prompt treatment of modifiable risk factors. Aggressive treatment of risk factors for nephropathy, such as blood pressure, low-density lipoprotein cholesterol, and careful tacrolimus levels monitorization, should be part of islet transplant recipient care.

AB - Background. Proteinuria development and decrease in glomerular filtration rate (GFR) have been observed after successful islet transplantation. The aim of this study was to determine clinical, laboratory, and immunosuppressant-related factors associated with kidney dysfunction in islet transplant recipients. Methods. A retrospective cohort study was conducted in 35 subjects submitted to pancreatic islet transplantation for treatment of unstable type 1 diabetes mellitus. Demographic, anthropometrical, and laboratory data, as well as immunosuppressive and antihypertensive therapy were recorded. Kidney function was assessed by albuminuria and estimated GFR (eGFR), calculated by modification of diet in renal disease formula. Results. Age was the only independent risk factor for low eGFR (<60 mL/min/1.73 m 2) (odds ratio [OR]=1.78 [1.22-2.61]). Low-density lipoprotein cholesterol (OR=2.90 [1.37-6.12]) and previous microalbuminuria (OR=6.42 [1.42-29.11]) were risk factors for transient macroalbuminuria. Interestingly, tacrolimus was a protective factor for macroalbuminuria (OR=0.12 [0.06-0.26]). Six of 30 (20%) normoalbuminuric subjects at baseline progressed to microalbuminuria. No subject developed sustained macroalbuminuria. Surprisingly, overall eGFR remained stable during follow-up (before transplant: 74.0±2.0; during immunosuppressive therapy: 75.4±2.8; and after withdrawal: 76.3±5.3 mL/min/1.73 m 2; P<0.05). Even subjects with low eGFR and microalbuminuria at baseline (n=10) maintained stable values posttransplantation (61.13±3.25 mL/min/1.73 m 2 vs. 63.32±4.36 mL/min/1.73 m 2, P=0.500). Conclusions. Kidney function remained stable after islet transplantation alone. The unchanged kidney function found in this sample may be attributed to healthier kidney status at baseline and possibly to prompt treatment of modifiable risk factors. Aggressive treatment of risk factors for nephropathy, such as blood pressure, low-density lipoprotein cholesterol, and careful tacrolimus levels monitorization, should be part of islet transplant recipient care.

KW - Albuminuria

KW - Blood pressure

KW - Islet transplantation

KW - Kidney function

KW - Lipids

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