ABSTRACT
Aim of the study: Intestinal transplantation (IT) is a life-saving procedure for carefully selected patients with intestinal failure. We evaluated patients who had undergone simultaneous intestinal and kidney transplantation (SIKT) to determine whether UK guidelines for inclusion of a renal allograft (dialysis dependent or estimated glomerular filtration rate ((eGFR)) < 45 ml/min/1.73 m2) are justified. Methods: A single centre analysis was undertaken of adults undergoing IT at the Cambridge Transplant Centre between December 2007 and January 2016. A prospectively maintained database was used to identify SIKT recipients and determine outcomes. Results: Over this period, 63 intestinal transplants were performed. Seven (11.1%) recipients received a SIKT. Five were pre-dialysis (median eGFR 29 ml/min/1.73 m2, range 16–36 ml/min/1.73 m2). One recipient was on dialysis, and one needed bilateral nephrectomy at transplant. There were no primary kidney allograft failures and at three months, the median eGFR (55 ml/min/1.73 m2 range 39–124) was similar to recipients of IT alone (median eGFR 56 ml/min/1.73 m2 range 17–143 ml/min/1.73 m2). Two recipients required dialysis due to sepsis related kidney injury and died from multi-organ failure (20 and 63 months). Two died with a functioning renal transplant (10 and 15 months). The remaining three patients are alive at follow up (12–96 months) with an eGFR of 20–45 ml/min/1.73 m2. Conclusion: Patients with significant renal impairment (eGFR <45 ml/min/1.73 m2), and receiving dialysis may benefit from SIKT. Patient survival and renal function are broadly comparable to those undergoing IT alone. Further studies are required to justify allocation of a kidney to this complex high risk group.
ABBREVIATIONS
CMV | = | Cytomegalovirus |
DGF | = | Delayed Graft Function |
eGFR | = | estimated glomerular filtration rate |
FAP | = | Familial Adenomatous Polyposis |
HLA | = | Human leucocyte antigen |
IFALD | = | Intestinal Failure Associated Liver Disease |
IT | = | Intestinal Transplantation |
MMVT | = | Modified Multi-visceral Transplant |
MVT | = | Multi-visceral Transplant |
NASIT | = | National Adult Small Intestinal Transplant Forum |
NHSBT | = | NHS Blood & Transplant |
PCP | = | Pneumocystis carinii pneumonia |
PJP | = | Pneumocystis jirovecii pneumonia |
PMVT | = | Porto-mesenteric vein thrombosis |
RRT | = | Renal Replacement Therapy |
SIKT | = | Simultaneous Intestinal and Kidney transplant |
WMAI | = | Widespread mesenteric arterial ischaemia |
DECLARATION OF INTEREST
None of the authors have any conflicts of interest to declare. The authors alone are responsible for the content and writing of the paper.