Risk factors for renal dysfunction after isolated intestinal transplantation.

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. [ABSTRACT FROM AUTHOR]