Decline in renal function following intestinal transplant: is the die cast at 3 months?. Issue 5 (24th February 2021) - Rutter, Charlotte S.
Abstract: Introduction: This study reports the incidence of chronic kidney disease (CKD) after intestinal transplant (IT) at a single, adult center in the United Kingdom. Methods: A retrospective review of IT was undertaken. Methods of renal function assessment pre‐transplant were compared. Post‐transplant renal function and renal sparing strategies were analyzed. Results: There was a 30% variation ( p < .001) in estimated glomerular filtration rate (eGFR) and normalized GFR at assessment. In the first 3 months post‐transplant, there was a 40% decline in eGFR which was irreversible. Liver inclusion was not protective with similar eGFR at 3 months (60 ml/min/1.73 m 2 ) compared with IT (55 ml/min/1.73 m 2 ). The rate of decline in the first 2 months was less in multivisceral transplant (MVT; 21%) than IT (52%) suggesting surgical magnitude did not contribute. Thirty percentage of recipients had acute cellular rejection post‐transplant; 58% of these were in the first 3 months with a higher proportion in MVT (64%) than IT (27%). Tacrolimus exposure did not correlate with decline in renal function over the first 3 months post‐transplant. Conclusion: We demonstrated a 40% decline in renal function within 3 months post‐IT which was irreversible despite renal sparing strategies. Early intervention should be considered in patients with an acute decline in this post‐transplant period.