Long-term outcomes of patients with kidney and intestine-containing graft co-transplantation

Transplant is the standard of care for patients with kidney or intestine failure. However, in patients with both kidney and intestine failure, it is unclear whether simultaneous or delayed transplant is preferred. This study explores survival and graft-failure outcomes for simultaneous (SK), delayed (DK), and no kidney (NK) transplantation in the setting of simultaneous intestinal and kidney failure.

Scientific Registry of Transplant Recipients was queried between January 1994 and December 2023 for all first-time intestine transplant recipients undergoing preoperative peritoneal or hemodialysis. Patients were grouped by kidney transplant timing. Bivariate analyses were conducted on demographics, including age, gender, race, ethnicity, insurance status, and diabetes status. Censured survival curves were developed for overall survival and intestinal graft failure-free survival. All statistics were conducted on SAS Academic.

A total of 54 patients (8 NK, 39 SK, 7 DK) were included. DK patients had both greater overall survival (p = 0.029) and graft failure-free survival (p = 0.020). Adjusted models with survival time measured from time of kidney transplant showed a clinically significant trend for both graft and overall survival for DK patients.

Patients with end stage renal disease and intestinal failure may benefit from delayed kidney transplantation. As this is a rare situation with few instances in large databases, further research would be beneficial.