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Renal function after pediatric intestinal transplant.

T Ueno1, T Kato, J Gaynor

  • 1Department of Surgery, University of Miami/Jackson Memorial Medical Center, 1801 NW 9th Avenue, Miami, FL 33136, USA.

Transplantation Proceedings
|August 16, 2006
PubMed
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Pediatric intestinal transplant recipients experienced a significant 19% decline in kidney function within two years. Higher tacrolimus levels (over 13.5 ng/mL) in the first year predicted this renal impairment.

Area of Science:

  • Pediatric Gastroenterology
  • Nephrology
  • Transplant Surgery

Background:

  • Intestinal transplantation is a complex procedure for end-stage intestinal failure.
  • Tacrolimus is a crucial immunosuppressant but can be nephrotoxic.
  • Long-term renal function after pediatric intestinal transplantation requires careful monitoring.

Purpose of the Study:

  • To evaluate long-term kidney function in pediatric patients following intestinal transplantation.
  • To identify predictors of renal impairment, specifically focusing on tacrolimus levels.

Main Methods:

  • Analysis of data from 44 pediatric patients surviving >2 years post-intestinal transplant (1994-2002).
  • Kidney function assessed via serum creatinine and calculated glomerular filtration rate (GFR) using the Schwartz formula.

Related Experiment Videos

  • Tacrolimus levels monitored and correlated with renal function outcomes at 18-24 months.

    • Main Results:

    • Mean GFR decreased from 138 mL/min/1.73 m(2) pre-transplant to 102 mL/min/1.73 m(2) at 18-24 months post-transplant (81% of pre-transplant value, P < .0001).
    • Tacrolimus levels >13.5 ng/mL during the first 12 months significantly predicted impaired renal function (GFR < 90 mL/min/1.73 m(2)) at 2 years (P = .001).
    • Only patient age correlated with renal function; transplant type and rejection episodes did not.

    Conclusions:

    • Pediatric intestinal transplantation leads to a significant and sustained decline in renal function by two years post-transplant.
    • Early post-transplant tacrolimus levels are a critical predictor of subsequent nephrotoxicity.
    • Close monitoring and potential optimization of tacrolimus dosing are essential to preserve kidney function in these patients.