Decline in renal function following intestinal transplant: is the die cast at 3 months?

Rutter, Charlotte; Russell, Neil; Sharkey, Lisa; Amin, Irum; Butler, Andrew

doi:10.1111/ctr.14249

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…No simultaneous living kidney and intestinal donation was reported, probably by concern for donor safety. 41,42 There have been no reported deaths or major complications. [43][44][45][46][47][48] Wu et al reported in 40 donors 1 intraoperative bleeding, 1 small bowel obstruction (conservatively treated), and 1 incisional hernia.…”

Section: Discussionmentioning

confidence: 99%

“…However, based on the reported series, the overall risk of intestinal donation (segmental bowel resection) is limited and probably lower than that for kidney/liver donation. No simultaneous living kidney and intestinal donation was reported, probably by concern for donor safety 41,42 . There have been no reported deaths or major complications 43–48 .…”

Section: Discussionmentioning

confidence: 99%

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Outcome after Intestinal Transplantation from Living versus Deceased Donors

et al. 2023

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Objective: To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short- and long-term outcome to a propensity-matched cohort of deceased donors. Summary Background Data: ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote centers collaborations. Methods: Based on the ITR, 4156 ITx were performed between January 1987 and April 2019 of which 76 (1.8%) were LD including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/gender, weight, region, IF-cause, re-transplant, pre-transplant status, ABO compatibility, immunosuppression and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. Results: Most LD were performed in North-America (61%) followed by Asia (29%). Mean recipient age was: 22 years; BMI: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. 52% of patients were at home at time of transplant. One-/5-year patient-survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively (P=0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively (P=0.733). Acute rejection was diagnosed in 47% of LD versus 51% of DD (P=0.723). Conclusion: Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcome after Intestinal Transplantation from Living versus Deceased Donors

et al. 2023

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“…This is described in detail previously. 27 Briefly, all patients received induction immunosuppression (alemtuzemab 30 mg and intravenous methylprednisone). A second dose of alemtuzemab was given on day 4 if there was no elevated risk of sepsis (collections, fistulas, or abdominal sepsis).…”

Section: Methodsmentioning

confidence: 99%

Treatment of Complex Desmoid Tumors in Familial Adenomatous Polyposis Syndrome by Intestinal Transplantation

Canovai,

Butler,

Clark

et al. 2024

Transplantation Direct

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Background. Desmoid tumors are fibroblastic lesions which often have an unpredictable and variable clinical course. In the context of familial adenomatous polyposis (FAP), these frequently occur intra-abdominally, especially in the small-bowel mesentery resulting in sepsis, fistulation, and invasion of the abdominal wall and retroperitoneum. In selected cases where other modalities have failed, the most radical option is to perform a total enterectomy and intestinal transplantation (ITx). In this study, we present our center’s experience of ITx for desmoid in patients with FAP. Methods. We performed a retrospective review of our prospectively collected database between 2007 and 2022. All patients undergoing ITx for FAP-related desmoid were included. Results. Between October 2007 and September 2023, 144 ITx were performed on 130 patients at our center. Of these, 15 patients (9%) were for desmoid associated with FAP (7 modified multivisceral transplants, 6 isolated ITx, and 2 liver-containing grafts). The median follow-up was 57 mo (8–119); 5-y patient survival was 82%, all with functioning grafts without local desmoid recurrence. These patients presented us with several complex surgical issues, such as loss of abdominal domain, retroperitoneal/abdominal wall involvement, ileoanal pouch–related issues, and the need for foregut resection because of adenomatous disease. Conclusions. ITx is a viable treatment in selected patients with FAP and extensive desmoid disease. The decision to refer for ITx can be challenging, particularly the timing and sequence of treatment (simultaneous versus sequential exenteration). Delays can result in additional disease burden, such as secondary liver disease or invasion of adjacent structures.

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“…In IT recipients, the benefit of CNI minimization/sparing strategies appears to be limited in terms of preserving renal function. Rutter et al [ 75 ] in their single center study demonstrated significant decline in renal function irrespective of tacrolimus exposure. Herlenius et al [ 76 ], in their study of 10 IT recipients, noted that 4 patients were switched from CNI to sirolimus based regimen.…”

Section: Diagnosis and Management Of Ckd Post Non-kidney Sotmentioning

confidence: 99%

Kidney disease in non-kidney solid organ transplantation

Swanson¹

2022

WJT

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Kidney disease after non-kidney solid organ transplantation (NKSOT) is a common post-transplant complication associated with deleterious outcomes. Kidney disease, both acute kidney injury and chronic kidney disease (CKD) alike, emanates from multifactorial, summative pre-, peri- and post-transplant events. Several factors leading to kidney disease are shared amongst solid organ transplantation in addition to distinct mechanisms unique to individual transplant types. The aim of this review is to summarize the current literature describing kidney disease in NKSOT. We conducted a narrative review of pertinent studies on the subject, limiting our search to full text studies in the English language. Kidney disease after NKSOT is prevalent, particularly in intestinal and lung transplantation. Management strategies in the peri-operative and post-transplant periods including proteinuria management, calcineurin-inhibitor minimization/ sparing approaches, and nephrology referral can counteract CKD progression and/or aid in subsequent kidney after solid organ transplantation. Kidney disease after NKSOT is an important consideration in organ allocation practices, ethics of transplantation. Kidney disease after SOT is an incipient condition demanding further inquiry. While some truths have been revealed about this chronic disease, as we have aimed to describe in this review, continued multidisciplinary efforts are needed more than ever to combat this threat to patient and allograft survival.

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Decline in renal function following intestinal transplant: is the die cast at 3 months?

Cited by 4 publications

References 19 publications

Outcome after Intestinal Transplantation from Living versus Deceased Donors

Outcome after Intestinal Transplantation from Living versus Deceased Donors

Treatment of Complex Desmoid Tumors in Familial Adenomatous Polyposis Syndrome by Intestinal Transplantation

Kidney disease in non-kidney solid organ transplantation

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