title: Renal function and histology in children after small bowel transplantation.
abstract: CKD is a frequent long-term complication after SBTx. CNIs are a well-known factor, but probably not the only cause. We assessed the incidence, risk factors, and severity of CKD in 27 children with SBTx (15 combined liver/SBTx) and prednisone/TAC-based maintenance immunosuppression. Median follow-up was seven yr (3-21). A renal biopsy was performed in 14 patients, 1-18 yr post-SBTx. A reduced GFR was observed in 17 children (63%) during the follow-up with none requiring dialysis. CNI toxicity was observed in 11/14 biopsies, as early as two yr post-transplant, and could occur with a normal mGFR. The dose of TAC was reduced by 50% in 13 patients with CKD and/or significant kidney histological lesions, and six were also given MMF. This led to a significant improvement in renal function: mGFR normalized in eight patients and improved or stabilized in five. No rejection occurred. At last follow-up, 37% had CKD stage 2 and 15% had CKD stage 3. In conclusion, CKD is frequent in children after SBTx and probably multifactorial. Less nephrotoxic immunosuppressive protocols may improve mGFR and should be further considered. The kidney histology helps in designing personalized immunosuppression strategies for patients.
authors.affiliation: Pediatric Nephrology Unit, Reference Center for Hereditary Renal Diseases in Children and Adolescent (MARHEA), Paris, France.
authors.forename: Olivia
authors.initials: O
authors.lastname: Boyer
authors.forename: Cristian
authors.initials: C
authors.lastname: Noto
authors.forename: Natacha Patey-Mariaud
authors.initials: NP
authors.lastname: De Serre
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Gubler
authors.forename: Michèle
authors.initials: M
authors.lastname: Dechaux
authors.forename: Olivier
authors.initials: O
authors.lastname: Goulet
authors.forename: Patrick
authors.initials: P
authors.lastname: Niaudet
authors.forename: Florence
authors.initials: F
authors.lastname: Lacaille
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007410:Intestinal Diseases / Q000601:surgery; D007421:Intestine, Small / Q000637:transplantation*; D008297:Male; D051437:Renal Insufficiency / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use; D014180:Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus