Simultaneous Intestinal and Kidney Transplantation in Adults

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.

Keywords::

• intestinal transplant
• intestinal failure kidney transplant
• renal failure
• renal function

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.