Purpose: Single center study of Intestinal Transplant recipients to evaluate epidemiology of dialysis and renal transplantation (RT) following Intestinal transplantation (IT). 

Methods: 288 adult patients who underwent first IT between Jan 1990 and March 2014, either in isolation or along with other abdominal visceral organs, excluding kidney, were analyzed. Need for any dialysis or end stage renal disease (ESRD), defined as needing dialysis for more than 90 days or undergoing renal transplantation (RT) was evaluated. Study period was divided into era 1 (1990-1994), era 2 (1995-2001) and era 3 (2001-2014) based on immunosuppression protocol used. Univariable and multivariable Cox proportional hazards model was used to assess predictors of dialysis, ESRD and mortality. Kaplan-Meier estimation was used to assess survival following IT, RT and dialysis initiation. 

Results: 71 of 288 (24.7%) patients needed dialysis at some point following IT during a median follow up of 5.7 years (range 0 to 22 years), yielding an incidence rate of 46.6 per 1000 PY. Of these, 36 (12.5%) progressed to requiring chronic dialysis with an incidence rate of 24 per 1000 PY. Cumulative probabilities of any dialysis at 1, 3 and 5 years were 21%, 48% and 55% respectively while the same for chronic dialysis were 10%, 29% and 38%. Median survival after dialysis initiation was 0.47 years with a three year survival of 21%. On multivariable analysis, hazard ratio (HR) for death after IT was 12.06 (p<0.001) for patients needing any dialysis and 8.09 (p<0.001) for those with ESRD. Variables significantly associated with increased risk of ESRD were baseline creatinine at IT (HR 3.4, p=0.007) and use of liver containing grafts (HR 2.01 (p<0.044) 17 of 288 (6%) patients received renal transplantation after IT. 35% were living donor transplants and 47% were pre-emptive. 1 and 3 year graft and patient survivals were 70% and 49% respectively. All graft losses were secondary to death with a functioning graft, with sepsis being the most common cause of death (55%).

Conclusions: Dialysis after intestinal transplantation is common and associated with significantly increased risk of mortality. Renal allograft survival with history of IT is suboptimal, mainly due to death with a functioning graft.