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Original Research

Simultaneous Intestinal and Kidney Transplantation in Adults

, FRCS, , MRCP, , FRCS, , , FRCS, , FRCS & , FRCS show all
Pages 283-289 | Received 17 Sep 2017, Accepted 22 Nov 2017, Published online: 15 Jan 2018
 

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.

Additional information

Funding

The research was supported by the NIHR Cambridge Comprehensive Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the department of Health or NHSBT.

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