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

Introduction: Using data from the Scientific Registry of Transplant Recipients (SRTR), cumulative incidence, risk factors for, and impact on survival of severe chronic kidney disease (CKD) in intestinal transplantation (ITx) recipients were assessed. Methods: First-time adult ITx recipients transplanted in the United States between January 1, 1990 and December 31, 2012 were included. Severe CKD after ITx was defined as: glomerular filtration rate (GFR) <30 mL/min/1.73 m², chronic hemodialysis initiation, or kidney transplantation (KTx). Survival analysis and extended Cox model were conducted. Results: The cumulative incidence of severe CKD 1, 5, and 10 years after ITx was 3.2%, 25.1%, and 54.1%, respectively. The following characteristics were significantly associated with severe CKD: female gender (HR 1.34), older age (HR 1.38/10 year increment), catheter-related sepsis (HR 1.58), steroid maintenance immunosuppression (HR 1.50), graft failure (HR 1.76), ACR (HR 1.64), prolonged requirement for IV fluids (HR 2.12) or TPN (HR 1.94), and diabetes (HR 1.54). Individuals with higher GFR at the time of ITx (HR 0.92 for each 10 mL/min/1.73 m² increment), and those receiving induction therapies (HR 0.47) or tacrolimus (HR 0.52) showed lower hazards of severe CKD. In adjusted analysis, severe CKD was associated with a significantly higher hazard of death (HR 6.20). Conclusions: The incidence of CKD after ITx is extremely high and its development drastically limits post-transplant survival.