RENAL FUNCTION IMPAIRMENT AFTER ISLET TRANSPLANT ALONE (ITA) OR ISLET-AFTER-KIDNEY (IAK) TRANSPLANTATION USING A SIROLIMUS-TACROLIMUS-BASED REGIMEN
Bibliographic record
Abstract
P440 Aims: The Edmonton protocol, a steroid-free immunosuppressive regimen including sirolimus, low-dose tacrolimus and dacluzimab has greatly improved the outcome of islet transplantation. This regimen is believed to exhibit limited nephrotoxicity. The aim of our study was to assess its real impact on renal function after ITA and IAK procedures. Methods: From July 2002 to April 2003, 10 patients (female/male: 5/5, median age:41 years) received their first islet infusion in 5 ITA and 5 IAK procedures, the latter 12.6 years (3.5-22.7) after kidney transplant. A median of 12885 IEq/Kg were injected in one, two or three infusions (2, 6 and 2 cases). Eight patients achieved insulin-independance, 5 being currently free of insulin. Data were prospectively collected over a median follow-up period of 10 months. Renal function was monitored by measured or calculated creatinin clearance (CCl), proteinuria, micro-albuminuria (MA) and, when indicated, by renal biopsies. Results: Four patients (2 ITA, 2 IAK) have experienced a marked decrease of CCl (>20%). Among these four patients, 3 patients presented a significant increase of MA or/and proteinuria. In the ITA group, two patients presented an isolated increase of MA and/or proteinuria. Two patients (1 IAK, 1 ITA) already had proteinuria at the time they were put on the waiting list, including 1 IAK patient with already impaired kidney function (CCl = 36). The two ITA patients who decreased CCl were the older of the series (age 56 and 58). Two of 3 IAK patients who decreased CCl had an established graft for > 15 years. One experienced humoral rejection 5 months after the first islet infusion. There was no obvious relationship between the decrease of CCl and insulin-independance or immunosupression blood levels. Conclusions: In our experience, the impairment of renal function is not uncommon after ITA and IAK using an Edmonton-inspired immunosuppression protocol. Age over 55 years, a long established kidney graft or a borderline renal function appear as potential risk factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".