Including colon in intestinal transplantation: a focus on post‐transplant renal function – a retrospective study

Abstract

Summary Intestinal transplant recipients experience a high rate of renal complications secondary to dehydration due to increased ostomy output. It is hypothesized that inclusion of donor colon in the intestinal allograft may improve renal function in patients without functional native colon by improving fluid absorption. A single‐center retrospective study of intestinal transplant recipients compared outcomes of patients receiving en bloc colon as part an intestinal allograft (ICTx), and those not receiving colon (CCNTx), as well as a control group of intestinal transplant recipients with functional native colon (ITx). Forty‐seven patients (ICTx n = 17, CCNTx n = 15, ITx n = 15) were studied. One‐year post‐transplant renal function, as measured by change in glomerular filtration rate (GFR) and blood urea nitrogen (BUN) from baseline, was superior in ICTx (mean delta‐GFR of −1.31 and delta‐BUN of −1.46) compared to CCNTx (−6.54 and 17.54, P = 0.05 and P = 0.17, respectively) and similar to the ITx controls (0.55 and 2.09). Recipients of donor colon experienced a higher rate of ileostomy reversal when compared to CCNTx (62.5% vs. 20%, P = 0.0008), which was similar to the ITx controls (60%). These findings support the inclusion of en bloc donor colon in the intestinal allograft for recipients without functional native colon.

Innovative surgical techniques in the intestine and multivisceral transplant

“…In various intestinal transplant scenarios, inclusion of the colon is customary, as it is linked to reduced dehydration, diarrhea rates, and heightened patient satisfaction and quality of life [29]. Studies from the University of Nebraska Medical Center indicated better posttransplant renal function in patients who received en-bloc colon in an IIT (mean delta glomerular filtration rate of −1.31 and delta blood urea nitrogen of −1.46) than patients not receiving colon (−6.54 and 17.54, respectively), with statistical significance ( P = 0.05 and P = 0.017 respectively) [33 ▪ ].…”

Risk factors for renal dysfunction after isolated intestinal transplantation

“…9,10 Strategies to limit malabsorptive fluid losses, such as colon-inclusive intestinal allografts, have also been recommended to augment renal recovery. 11,12 An analysis of a recent shift in our institution's practice of avoiding stoma creation at the time of transplant indicated a trend toward preservation of kidney function, although this did not reach statistical significance. 13 This study was performed to better characterize the incidence as well as further define potential risk factors for the development of CKD in intestinal transplant recipients.…”

Nutrition care for the adult post–intestinal transplant patient

“…These can potentially mitigate the risk of renal dysfunction. [18][19][20] T A B L E 1 International indications for intestinal transplant from the Intestinal Transplant Registry. Although previous studies highlighted these physiological advantages and improved quality of life for recipients of colonic inclusion, conflicting results have been reported regarding its impact on renal protection.…”

“…The benefits of colonic allograft encompass improved fluid absorption, residue breakdown, and stool patterns. These can potentially mitigate the risk of renal dysfunction 18–20 . Although previous studies highlighted these physiological advantages and improved quality of life for recipients of colonic inclusion, conflicting results have been reported regarding its impact on renal protection.…”