Introduction: It is well known that RF is a frequent complication in non-renal transplantation of solid organs. This issue is especially important in Itx.

Aim: Analyze our experience with such complication in order to find out solutions.

Patients and Methods: Between 2004 and 2013, we have performed 21 Itx in 19 adult patients. Four were multivisceral and 17 isolated Itx. Alemtuzumab is used as an induction agent  follow by tacolimus (TAC) as maintenance with or without steroids. Renal function was assessed before Itx and during the perioperative period, by means of creatinine level, GFR and creatinine clearance when possible.

Results: About 93 % of the patients under long term home parenteral nutrition (HPN);  had complications HPN related (13/14 patients) .  Main cause for transplant was irresectable desmoids tumor (37%), follow by vascular thrombosis (21%) and others. Medical complications were frequent, especially infectious diseases that were the most common complication (51% of all medical complications) from central line infection and related with the surgical mesh for temporary closure of the wound in most cases. We make universal prophylaxis against CMV and Pneumocystis carinii based upon CD4 counting. Surgical complications were frequent, but most of them (>50%) mild and related to the surgical mesh, but leading to a great number of reoperations and prolonged in hospital stay. Acute rejection (AR) is very frequent (>50%) but mild in more than half of the events, but requiring high doses of immunosuppressant drugs. RF was very frequent in our experience (68,4%; 13/19 patients) and the 14% of all medical complications. Causes leading to RF were multiple (Ileostomy, immunosuppression and medical treatment). Dialysis was needed in 3 patients in the early postoperative period. At this moment there is just 1 patient awaiting a kidney transplant.  Ileostomy closure was performed in 5/12 patients alive. In 3 patients renal function improved and in the other 2 remains stable after ileostomy closure. Of the 7 patients that remain with the functioning ileostomy 1 is awaiting a kidney transplant, 4 remain with a normal renal function and 2 have a real impaired renal function but with no need for dialysis at the moment.

Conclusions: RF is a real problem dealing with Itx patients due to multiple causes. Increases in hospital stay, morbidity and is a frequent cause for in hospital readmission in these patients. Almost all patients had an impaired renal function at the time of discharged, but this is likely to improve when the ileostomy is closed. Adding other immunosuppressant drugs in order to minimize TAC and trying to perform an ileostomy closure as soon as possible, might prevent RF.