The high incidence of severe chronic kidney disease after intestinal transplantation and its impact on patient and graft survival

Huard, Geneviève; Iyer, Kishore; Moon, Jang; Doucette, John; Nair, Vinay; Schiano, Thomas D.

doi:10.1111/ctr.12942

Cited by 8 publications

(20 citation statements)

References 34 publications

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“…There is high incidence of kidney failure in CIF and ITx patients and in the latter is an independent risk factor for poor outcome. 36 Therefore, we have a low threshold to a add a kidney graft in case of significantnot yet terminalpretransplant kidney dysfunction. In our…”

Section: A C C E P T E Dmentioning

confidence: 99%

Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

et al. 2021

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Background: Intestinal Transplantation (ITx) is the most expensive abdominal organ transplant. Detailed studies about exact costs and cost-effectiveness compared to home parenteral nutrition (HPN) therapy in chronic intestinal failure (CIF) are lacking. The aim is to provide an in-depth analysis of ITx costs and evaluate cost-effectiveness compared to HPN. Methods: To calculate costs before and after ITx, costs were analyzed in 12 adult patients. To calculate costs of patients with uncomplicated CIF, 28 adult, stable HPN patients were studied. Total costs including surgery, admissions, diagnostics, HPN therapy, medication, and ambulatory care were included. Median (range) costs are given. Results: Costs prior to ITx were €69 160 (60 682-90 891) in year 2, and €104 146 (83 854-186 412) in year 1. After ITx, costs were €172 133 (122 483 -351 407) in the 1 st year, €40 619 (3 905 -113 154) in the 2 nd year, and dropped to €15 743 (4 408 -138 906) in the 3 rd year. In stable HPN patients, the costs were €83 402 (35 364 -169 146) in the 1 st year, €70 945 (31 955 -117 913) in the 2 nd year, and stabilized to €60 242 (29 161-238 136) in the 3 rd year. Conclusion:ITx, although initially very expensive, is cost-effective compared to HPN in adults by year 4, and cost saving by year 5.

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Section: A C C E P T E Dmentioning

confidence: 99%

Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

et al. 2021

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“…One of the major challenges following IT is the significant decline in renal function with associated morbidity and mortality 6,7 . Patients considered for IT or MVT undergo a comprehensive assessment including determination of renal function.…”

Section: Discussionmentioning

confidence: 99%

“…The reported incidence of CKD in IT is variable with a 5‐year cumulative incidence of 21.3% published in 2003 6 . More recently, Huard et al 7 reported a cumulative incidence of 3.2%, 25.1%, and 54.1% at 1, 5, and 10 years after IT. This was associated with a sixfold increase in mortality.…”

Section: Introductionmentioning

confidence: 99%

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

Rutter

Russell

Sharkey

et al. 2021

Clinical Transplantation

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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 m2) compared with IT (55 ml/min/1.73 m2). 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.

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“…About 18.1% of cases had a GFR <30 mL/min, 7.4% required initiation of chronic hemodialysis, while 4.4% needed a subsequent kidney transplant. Development of severe CKD was an independent risk factor for mortality with hazard ratio of 6.2 …”

Section: Discussionmentioning

confidence: 99%

Kidney allograft survival outcomes in combined intestinal‐kidney transplant: An analysis of the UNOS/OPTN database 2000‐2014

Moinuddin

Yaqub

Taber

et al. 2018

Clinical Transplantation

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The high incidence of severe chronic kidney disease after intestinal transplantation and its impact on patient and graft survival

Abstract: The incidence of CKD after ITx is extremely high and its development drastically limits post-transplant survival.

Cited by 8 publications

References 34 publications

Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

Cost-effectiveness of Intestinal Transplantation Compared to Parenteral Nutrition in Adults

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

Kidney allograft survival outcomes in combined intestinal‐kidney transplant: An analysis of the UNOS/OPTN database 2000‐2014

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