Chronic kidney disease--a common and serious complication after intestinal transplantation.
BACKGROUND
Chronic kidney disease after organ transplantation is a serious complication that negatively impacts on long-term patient survival. We describe long-term renal function after intestinal transplantation by serial measurements of glomerular filtration rates (GFR) with Chromium EDTA clearance.


METHODS
Ten patients with at least 6 months survival form the basis of this report. Glomerular filtration rate measurements were performed at baseline, 3 months posttransplantation, and yearly thereafter. Median follow-up time for the cohort was 1.5 years (0.5-7.8 years). Tacrolimus (Prograf) was discontinued in four patients because of impaired renal function. These four patients were switched to sirolimus (Rapamune) at 11, 18, 24, and 40 months posttransplantation.


RESULTS
Median baseline GFR was 67 (22-114) mL/min/1.73 m. In the adult patients, GFR 3 months posttransplantation had decreased to 50% of the baseline. At 1 year, median GFR in the adult patients was reduced by 72% (n=5). Two patients developed renal failure within the first year and required hemodialysis. One of the pediatric patients fully recovered her renal function, the second pediatric patient lost 20% of her baseline GFR at 6 months posttransplantation. Glomerular filtration rate calculated with the modified diet in renal disease formula consistently overestimated GFR by approximately 30% compared with measured GFR.


CONCLUSIONS
Chronic kidney disease and renal failure are common after intestinal transplantation. These two factors significantly contribute to poor long-term survival rates. Measurements of GFR may help to identify those individuals at risk for developing chronic kidney disease to implement renal sparing strategies.
Herlenius
Gustaf
G
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. Gustaf.herlenius@gmail.com
Fägerlind
Mattias
M
Krantz
Marie
M
Mölne
Johan
J
Olausson
Michael
M
Gäbel
Markus
M
Friman
Vanda
V
Oltean
Mihai
M
Friman
Styrbjörn
S
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002860:Chromium Radioisotopes; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D018450:Disease Progression; D004492:Edetic Acid; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007422:Intestines / Q000637:transplantation*; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D002860:Chromium Radioisotopes; D007166:Immunosuppressive Agents; D004492:Edetic Acid; D020123:Sirolimus; D016559:Tacrolimus