Renal function impacts outcomes after intestinal transplantation.
BACKGROUND
Although renal dysfunction (RD) has been commonly associated with poor outcome after other solid organ transplants, it has not been studied in detail after intestinal transplantation (ITx). Here we provide a detailed analysis of renal function after ITx, and identify predictors of post-ITx RD.


METHODS
A retrospective analysis of patients undergoing ITx from 1991 to 2006 was performed. For each patient, the estimated glomerular filtration rate (eGFR) was compared with the normal GFR for age and gender to obtain the percent of normal eGFR. Chi-square analysis and log-rank tests were used to identify categorical variables associated with RD (eGFR <75% of normal) and to determine if RD was predictive of post-ITx survival.


RESULTS
Sixty-eight transplantations were performed in 62 patients. Overall patient survival at 1 and 5 years was 78% and 56%, respectively. Renal dysfunction was observed in 16% of patients post-ITx. The most frequent predictors of post-ITx RD were preoperative eGFR less than 75% of normal, pre-ITx location in the intensive care unit, and high-dose tacrolimus immunotherapy. An eGFR less than 75% of normal at days 7, 28, and 365 was predictive of poor patient survival (P<0.05).


CONCLUSIONS
This study provides the first detailed analysis of renal function after ITx. We identified specific risk factors for the development of RD in the first year post-ITx and found a significant association of RD with decreased long-term survival. Given the strong correlation of RD with poor outcome, preserving renal function may be key to improving long-term outcomes in ITx recipients.
Watson
Melissa J
MJ
UCLA Department of Surgery, Los Angeles, CA, USA.
Venick
Robert S
RS
Kaldas
Fady
F
Rastogi
Anjay
A
Gordon
Sherilyn A
SA
Colangelo
Joanna
J
Esmailian
Yvonne
Y
McDiarmid
Sue V
SV
Busuttil
Ronald W
RW
Farmer
Douglas G
DG
D000328:Adult; D002648:Child; D003422:Critical Care; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007422:Intestines / Q000637:transplantation*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D016559:Tacrolimus