Raffaele Girlanda, Basit Javaid, Elham Dadzan, Juan-Francisco Guerra, Cal Matsumoto, Thomas Fishbein

Georgetown Transplant Institute, Washington, DC, United States

Objective: Kidney dysfunction is common after solid organ transplantation. A major risk factor is the nephrotoxicity of immunosuppressive agents. Intestinal transplant (Itx) recipients typically receive heavy immunosuppression. We analyzed the extent of kidney dysfunction in Itx recipients and its impact on post-transplant outcomes.

Patients and Methods: 52 patients (M=31; F=21; median age 43 years; range 19-66) underwent 56 Itx between 2003- 2010. 5 patients undergoing simultaneous intestine and kidney tx were excluded. Ethnicity was African American in 10 patients, Asian in 1, Caucasian in 40 and Hispanic in 1. Maintenance immunosuppression consisted of tacrolimus, sirolimus and steroids. Median follow-up was 21 months (0-85). We analyzed pre-Itx kidney function by serum creatinine, eGFR and proteinuria. Post Itx we analyzed serum creatinine at 1, 3, 6, 12, 24, 36 months and tacrolimus trough levels at week 1, 2, 3, 4 and months 3, 6, 12, 24 and 36.

Results: Median pre-Itx serum creatinine was 0.8 mg/dL (0.3-1.6); nine patients (16.7%) had a pre-Itx eGFR of <60 mL/min/1.73 m2. A significant number of patients had proteinuria pre-Itx (n=34; 66.7%). No patient required dialysis prior to Itx.

Post-Itx serum creatinine (mg/dL) was 1.6±1.3 at 1 month, 1.6±0.7 at 3 months, 1.6±0.8 at 6 months, 1.6±0.7 at 12 months, 1.5±0.7 at 24 months and 1.6±0.7 at 36 months (p<0.01).

Median trough tacrolimus levels (nanog/mL) were 18, 20, 16, 17 at week 1 to 4 post-Itx, 14, 11, 10, 10, 8 at 3, 6, 12, 24, 36 months respectively.

Five patients (10%) required temporary renal replacement therapy (2 CVVH and 3 HD) within the first 6 months after Itx. One patient underwent kidney transplant 2 years after Itx.

Twenty-two (42 %) patients died after a median of 8.5 months (range 0-73) post-Itx.
Pre-transplant kidney dysfunction (eGFR < 60 mL/min/1.73m2 ) was not associated with higher risk of death post-transplant (OR=1.6; 95% CI=0.37-6.59; p=0.54). Requirement for renal replacement therapy after transplantation was also not associated with increased risk of death (OR=1.5; 95% CI=0.19-11.5; p=0.69).

Conclusions: Kidney dysfunction is common in Itx patients. Pre-transplant kidney dysfunction or the need for post-transplant renal replacement therapy were not associated with increased risk of death after transplant.