Renal dysfunction following adult intestinal transplant under tacrolimus-based immunosuppression.
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.
Ueno
T
T
Department of Surgery, University of Miami/Jackson Memorial Medical Center, 1801 NW 9th Avenue, Miami, FL 33136, USA.
Kato
T
T
Gaynor
J
J
Velasco
M
M
Selvaggi
G
G
Nishida
S
S
Moon
J
J
Levi
D
D
Madariaga
J
J
Tzakis
A
A
D000328:Adult; D003404:Creatinine / Q000378:metabolism; D003424:Crohn Disease / Q000601:surgery; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007410:Intestinal Diseases / Q000145:classification / Q000601:surgery; D007422:Intestines / Q000637:transplantation*; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects
D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus