Triphasic decline in kidney function after islet transplantation: sex-based differences and the impact of calcineurin inhibitor immunosuppression in a 20 year single-centre cohort
Authors' conclusion
Although calcineurin inhibitor-based immunosuppression induces rapid early eGFR decline, its progression slows substantially beyond 5 years. Female sex and lower pre-transplant eGFR independently predicted CKD progression. This sex disparity remains to be fully understood, as male and female recipients did not differ in baseline eGFR or tacrolimus exposure. These findings establish a long-term renal safety benchmark within the largest and longest-running ITA programme, and identify subgroups who are most likely to benefit from emerging calcineurin inhibitor-free strategies.
Study context
- Population
- Adults undergoing islet transplantation alone (ITA) for type 1 diabetes at the University of Alberta Hospital (1999–2018)adults undergoing ITA (41% male)
- Participants
- 223 adults
- Exposure
- Female recipients vs Male recipients
- Outcome
- eGFR decline rate
- Follow-up
- First year post-transplant
Main finding
As reported in the abstract
eGFR decline, first year (ml min-1 1.73 m-2 per year)
−11.52
95% CI −13.92, −9.00
eGFR decline, 1-5 years (ml min-1 1.73 m-2 per year)
−3.12
95% CI −3.84, −2.28
eGFR decline, 5-20 years (ml min-1 1.73 m-2 per year)
−1.08
95% CI −1.80, −0.36
Observational data: associations, not effects.
Further findings
Predictors of progression to stage 3b chronic kidney disease (CKD)
| Sub-distribution HR (95% CI) | P value | ||
|---|---|---|---|
| Female sexIndependent predictor | 2.17 (1.15–4.17) | P = 0.017 | |
| 0.20.5125Sub-distribution HR (log scale) |
| Outcome | Sub-distribution HR (per ml min-1 1.73 m-2) (95% CI) | P value | |
|---|---|---|---|
| Predictors of progression to stage 3b CKDBaseline eGFR (per ml min-1 1.73 m-2) · lower baseline eGFR independent predictor | 0.96 (0.94–0.98) | P = 0.0009 | |
| 0.512Sub-distribution HR (log scale) |
ml min-1 1.73 m-2 per year
| Outcome | Female recipients | Male recipients | P value |
|---|---|---|---|
| First-year eGFR decline by sexGreater first-year decline in female recipients | −14.79 (95% CI −17.92–-11.66) | −6.75 (95% CI −10.49–-3.01) | P = 0.0012 |
| First-year eGFR decline by baseline eGFRBaseline eGFR <60 ml min-1 1.73 m-2 vs Preserved function · similar first-year decline | P = 0.10 |
- First-year eGFR decline by baseline eGFR: Baseline eGFR <60 ml min-1 1.73 m-2 −3.99 (95% CI −13.31–5.33) ml min-1 1.73 m-2 per year
- First-year eGFR decline by baseline eGFR: Preserved function −12.03 (95% CI −14.57–-9.49) ml min-1 1.73 m-2 per year
Progression to stage 3b CKD · median of 6.4 years
- Progression to stage 3b CKD
- 21% of participants (47/222)
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →