Renal event outcomes in intestinal transplantation: results from a single-center experience.
BACKGROUND
Poor patient outcomes have been closely linked with perioperative renal function after most solid organ transplants, except intestinal transplantation (ITx). This study examined the effect of peri-ITx renal function on outcome.


METHODS
A retrospective review of all patients undergoing ITx since 1991 was completed and included 43 patients and 49 transplants. Serum creatinine (sCr) and calculated glomerular filtration rate were compared with peri-ITx and out to 5 years. A renal event (RE) was defined as acute renal failure, immunotherapeutic change driven by poor renal function, or hemodialysis. Comparisons were made based on primary immunotherapeutic regimens-induction interleukin-2 receptor antagonist (IL-2RA; n=31) or standard tacrolimus-based therapy (STD; n=18). Data was analyzed using standard statistical analysis.


RESULTS
The frequency of RE was: 60% (STD) versus 31% (IL-2RA) P<.05. RE-associated mortality was 63% (STD) and 27% (IL-2RA) P<.05. Overall mortality was associated with a RE in 50% (STD) and 37% (IL-2RA) of patients. Average sCr across all timepoints was 1.05 (STD) and 0.78 (IL-2RA) P<.003. Surviving patients with RE in STD tended to suffer prolonged renal insufficiency, whereas those in IL-2RA did not.


CONCLUSIONS
This is the first study examining outcomes after ITx related to renal function. Clearly, renal function and RE impacted outcomes. Obtaining RE-free survival and lessening the impact of RE when they do occur is of paramount importance. It appears that IL-2RA immunotherapy reduces RE and their associated morbidity.
Kaldas
F
F
Department of Surgery, Division of Transplantation, University of California-Los Angeles, Los Angeles, California 90095, USA. fkbruin8@yahoo.com
Farmer
D
D
Gordon
S A
SA
McDiarmid
S V
SV
Venick
R
R
Colangelo
J
J
Busuttil
R W
RW
D005919:Glomerular Filtration Rate; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome