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

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 ( IT x) recipients were assessed. Methods First‐time adult IT x recipients transplanted in the United States between January 1, 1990 and December 31, 2012 were included. Severe CKD after IT x was defined as: glomerular filtration rate ( GFR ) <30 mL/min/1.73 m 2 , chronic hemodialysis initiation, or kidney transplantation ( KT x). Survival analysis and extended Cox model were conducted. Results The cumulative incidence of severe CKD 1, 5, and 10 years after IT x 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 IT x ( HR 0.92 for each 10 mL/min/1.73 m 2 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 IT x is extremely high and its development drastically limits post‐transplant survival.