Simultaneous Intestinal and Kidney Transplantation in Adults
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 allograf...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2019-05-01
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| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2017.1409849 |
| _version_ | 1797684552050671616 |
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| author | Irum Amin Charlotte Rutter Adam Barlow Neil K. Russell J. Andrew Bradley Andrew Jackson Andrew J. Butler |
| author_facet | Irum Amin Charlotte Rutter Adam Barlow Neil K. Russell J. Andrew Bradley Andrew Jackson Andrew J. Butler |
| author_sort | Irum Amin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T00:31:25Z |
| format | Article |
| id | doaj.art-93a459dc6bce464a971c665c82a809f5 |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:31:25Z |
| publishDate | 2019-05-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-93a459dc6bce464a971c665c82a809f52023-09-15T10:12:29ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532019-05-0132428328910.1080/08941939.2017.14098491409849Simultaneous Intestinal and Kidney Transplantation in AdultsIrum Amin0Charlotte Rutter1Adam Barlow2Neil K. Russell3J. Andrew Bradley4Andrew Jackson5Andrew J. Butler6University of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalUniversity of Cambridge, Addenbrooke's HospitalAim 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.http://dx.doi.org/10.1080/08941939.2017.1409849intestinal transplantintestinal failure kidney transplantrenal failurerenal function |
| spellingShingle | Irum Amin Charlotte Rutter Adam Barlow Neil K. Russell J. Andrew Bradley Andrew Jackson Andrew J. Butler Simultaneous Intestinal and Kidney Transplantation in Adults Journal of Investigative Surgery intestinal transplant intestinal failure kidney transplant renal failure renal function |
| title | Simultaneous Intestinal and Kidney Transplantation in Adults |
| title_full | Simultaneous Intestinal and Kidney Transplantation in Adults |
| title_fullStr | Simultaneous Intestinal and Kidney Transplantation in Adults |
| title_full_unstemmed | Simultaneous Intestinal and Kidney Transplantation in Adults |
| title_short | Simultaneous Intestinal and Kidney Transplantation in Adults |
| title_sort | simultaneous intestinal and kidney transplantation in adults |
| topic | intestinal transplant intestinal failure kidney transplant renal failure renal function |
| url | http://dx.doi.org/10.1080/08941939.2017.1409849 |
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