Risk factors for renal dysfunction after isolated intestinal transplantation.

Autor: von Ahrens D; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA., Santeusanio AD; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.; Department of Pharmacy, Mount Sinai Hospital, New York, New York, USA., Weinberg AD; Department of Population Health Science and Policy, Mount Sinai Hospital, New York, New York, USA., Moon J; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA., Iyer KR; Recanati-Miller Transplantation Institute, Mount Sinai Hospital, New York, New York, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Jan; Vol. 38 (1), pp. e15228.
DOI: 10.1111/ctr.15228
Abstrakt: Introduction: Kidney dysfunction is a known complication of intestinal transplantation; however, the rate of development and risk factors for chronic kidney disease (CKD) remain poorly defined.
Methods: This was a single-center retrospective review of isolated adult intestinal allograft recipients from 2011 to 2019. Patients who died or experienced graft loss within 1-year or had a prior transplant were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation at 0-, 6- and 12-months post-transplant, and multivariable linear regression was performed to identify variables associated with adjusted eGFR at 1-year. Independent variables included age, ethnicity, BMI, history of diabetes/hypertension, vasopressor use, TPN and stoma days, urinary or bloodstream infections, intravenous contrast exposure, rejection, concomitant immunosuppression, and time above the therapeutic range of tacrolimus. Variables with a p < .1 in univariate analysis were considered for multivariable modeling.
Results: Thirty-three patients were included with a mean age of 43.9 ± 13.0. A mean 42.3% decline in eGFR was observed at 1-year post-transplant, with 15.2% of patients developing new stage 4/5 CKD. Factors associated with a greater decline in adjusted eGFR in the univariate model included increasing age, decreased BMI, stoma days, and vasopressor use. In the adjusted multivariable model patient age (β = -.77, p < .01) and stoma days (β = -.06, p < .01) remained significant. Tacrolimus and sirolimus exposure were not associated with decline in eGFR at 1 year.
Conclusions: Renal dysfunction is common following intestinal transplantation. The need for stoma creation should be carefully considered, and reversal should be performed when feasible for renal protection.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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