Renal Dysfunction Following Adult Intestinal Transplant Under Tacrolimus-Based Immunosuppression

Abstract

We analyzed data from the records of 24 adult patients who survived more than 2 years after intestinal transplantation performed between 1995 and 2002 under tacrolimus-based immunosuppression. Ages ranged from 19.3 to 59.2 years old (median 32.1 years). Tacrolimus cumulative level was defined as a sum of weekly average tacrolimus level over time. Kidney function was evaluated by the 6-month average serum creatinine level. Estimated creatinine clearance was calculated with the Cockcroft-Gault formula. Student’s t test was used for analysis. Primary diseases were mesenteric thrombosis ( n = 7), trauma ( n = 4), Crohn’s ( n = 3), Gardner’s ( n = 5), and others ( n = 7). Procedures were isolated intestinal transplant ( n = 10), liver and intestine ( n = 1), multivisceral transplant ( n = 9), or modified multivisceral transplant ( n = 4). Cumulative tacrolimus levels ranged between 1161 and 8623 ng⁎day/mL (median 4132 ng⁎day/mL) at 0 to 12 months. Pretransplant kidney function as mean creatinine clearance was 114 mL/min per 1.73 m 2 ( n = 24). Creatinine clearance decreased to a mean of 49.6 mL/min per 1.73 m 2 (43.5% of pretransplant) at 2 years ( P < .0001). The average creatinine clearance at 18 to 24 months in each patient with a cumulative tacrolimus level <4500 ng*day/mL was 63% ± 25% of preoperative creatinine clearance. In patients with a cumulative tacrolimus level >4500 ng*day/mL, it was 34% ± 17%. Cumulative tacrolimus level >4500 ng ng*day/mL was significantly associated with a decreased creatinine clearance at 2 years ( P = .006). Renal function decreased significantly after intestinal transplantation in adults. Cumulative tacrolimus level in the first year affected renal function at 2 years.