Predictors of End-Stage Renal Disease in Recipients of Pancreas Transplant Alone
Bibliographic record
Abstract
Introduction: Pancreas transplant alone (PTA) has become an accepted therapy for selected non-uremic pts with type 1 diabetes mellitus. The published literature suggests that there is reversibility of diabetic nephropathy after 5-10 years of successful PTA. There is evidence of development of histological lesions due to calcineurin inhibitor nephrotoxicity. Purpose: To determine predictors of end-stage renal disease (ESRD) after PTA. Methods: Retrospective cohort study including 43 pts (age 39±8 yrs) with PTA between June 1998 and March 2011. Immunosuppression consisted of ATG-induction, tacrolimus, mycophenolate mofetil, and corticosteroids. The pts were divided into 2 groups (GR): GR.1: 9 pts (4 women/5 men) with pre-Tx eGFR < 60 mL/min/1.73 m2 and GR.2: 34 pts (14 women/20 men) with pre-Tx eGFR >60 mL/min/1.73m2. We used multivariate analysis to identify independent predictors of ESRD. The mean pre-Tx eGFR in GR.1 was 44±8 vs. 101±21 mL/min/1.73 m2 in GR.2 (P< 0.0001). Pre-Tx proteinuria (g/d) was 1.6±1.5 in GR.1 vs. 1.2±1.6 and GR.2 (P=0.6). Duration of diabetes was 28±7 yrs in GR.1 vs. 25±7 yrs in GR.2 (P=0.2). Two pts received ACE and/or ARB in Gr.1 vs. 10 pts in GR.2 (P=1.0). Results: The incidence of ESRD requiring chronic dialysis at 1, 3 and 5 years was 0%, 28.57% and 61.9%, respectively in GR.1, and 0%, 8.2% and 12.5%, respectively in GR.2 (P=0.006). Significant predictors of ESRD requiring chronic dialysis included age (HR=0.7, CI: 0.563-0.873, P=0.001, higher risk in younger pts), gender (HR=0.09, CI: 0.012-0.664, P=0.018, higher risk in women), duration of diabetes mellitus pre-PTA (HR=1.24, CI: 1.025-1.510, P=0.02), and pre-PTA eGFR < 60/mL/min/1.73 m2 (HR=0.027, CI: 0.003-0.227, P=0.0009). There was no significant difference in tacrolimus dose and levels between both groups. Patient survival at 5 years was 89.9% in those with eGFR < 60 mL/min/1.73 m2 and 85.8% in those with eGFR >60 mL/min/1.73 m2 (P=0.73). Conclusion: Recipients of PTA with eGFR < 60 mL/min/1.73 m2 pre-Tx, younger pts, women, and those with a longer history of diabetes mellitus pre-Tx, were more likely to progress to ESRD requiring chronic dialysis. These factors may highlight pts that could benefit from closer kidney function monitoring and renal protection strategies. Future studies should determine modifiable predictors of ESRD, assess the outcomes of pts on chronic dialysis, and determine the timing and impact of kidney Tx.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".