Decline in renal function following intestinal transplant: is the die cast at 3months?

Abstract

This study reports the incidence of chronic kidney disease (CKD) after intestinal transplant (IT) at a single, adult center in the United Kingdom. A retrospective review of IT was undertaken. Methods of renal function assessment pre-transplant were compared. Post-transplant renal function and renal sparing strategies were analyzed. There was a 30% variation (p<.001) in estimated glomerular filtration rate (eGFR) and normalized GFR at assessment. In the first 3months post-transplant, there was a 40% decline in eGFR which was irreversible. Liver inclusion was not protective with similar eGFR at 3months (60ml/min/1.73m2 ) compared with IT (55ml/min/1.73m2 ). The rate of decline in the first 2months was less in multivisceral transplant (MVT; 21%) than IT (52%) suggesting surgical magnitude did not contribute. Thirty percentage of recipients had acute cellular rejection post-transplant; 58% of these were in the first 3months with a higher proportion in MVT (64%) than IT (27%). Tacrolimus exposure did not correlate with decline in renal function over the first 3months post-transplant. We demonstrated a 40% decline in renal function within 3months post-IT which was irreversible despite renal sparing strategies. Early intervention should be considered in patients with an acute decline in this post-transplant period.