Decline in native renal function early after bladder-drained pancreas transplantation alone

Background. Pancreas transplant alone (PTA) has become accepted therapy for select nonuremic patients with type 1 diabetes mellitus. However, PTA may lead to significant complications including a decline in native renal function. This study examines trends in native renal function during the first post-transplant year in PTA recipients with a spectrum of pretransplant glomerular filtration rates (GFR). Methods. Renal function was studied in 23 recipients of bladder-drained PTA who underwent transplantation from April 1998 through September 2001. GFR was measured by corrected iothalamate clearance at the time of transplant evaluation and 1 year posttransplant and also calculated using the Cockcroft-Gault method at the transplant evaluation; at the day of transplantation; and at 1, 6, and 12 months posttransplant. Results. Iothalamate clearance decreased in the first year in 96% of patients (22 of 23). The mean measured GFR decreased from 84±33 mL/min/1.73 m² pretransplant to 52±26 mL/min/1.73 m² at 1 year (P<0.001). Calculated creatinine clearance declined in the majority of patients at both 1 and 12 months after PTA, but some patients, including a few with low GFR, maintained stable renal function. Calculated GFR generally correlated well with measured GFR in most patients, with a few notable exceptions. One patient (baseline GFR, 42 mL/min/1.73 m²) developed renal failure in the first year after transplant and required kidney transplantation. Conclusions. Bladder-drained PTA results in a decline in native renal function in the majority of patients regardless of the pretransplant GFR. These data suggest the need for strategies to prevent or minimize the decline in renal function after PTA.