Session Time: 2:15pm-3:45pm
Presentation Time: 3:27pm-3:39pm
Location: Room 117
Background: Patient and graft survival rates after intestinal transplantation (ITx) have improved. More ITx recipients achieve long-term survival and are at risk for severe chronic kidney disease (sCKD). We performed a cohort study using data from the Scientific Registry of Transplant Recipients (SRTR) to assess the cumulative incidence, risk factors for and the impact on survival of sCKD in ITx recipients.
Methods: We included first-time adult ITx recipients transplanted between 01/01/1990 and 12/31/2012. The SRTR database contained follow-up (F/U) information up to 06/01/2014. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. SCKD after ITx was defined as one or more of the following: GFR <30 ml/min/1.73m2, or initiation of chronic hemodialysis, or kidney transplantation after ITx. Survival analysis was conducted to assess the cumulative incidence and the risk factors for sCKD after ITx as well as the impact of sCKD on post-transplant survival.
Results: The final cohort consisted of 843 adult ITx recipients. A total of 225 (26.7%) patients developed sCKD. The cumulative incidence of sCKD one, five and ten years after ITx was 3.2%, 25.1%, and 54.1%, respectively. The following pre-ITx characteristics were significantly associated with higher hazards of sCKD after ITx: female gender (HR 1.34), advanced age (HR 1.38 per ten year increment), and catheter-related sepsis (HR 1.58). After ITx, steroid maintenance immunosuppression (HR 1.50), graft failure (HR 1.76), acute cellular rejection (HR 1.64), prolonged requirement for IV fluids (HR 2.12) or TPN (HR 1.94), and diabetes (HR 1.54) were all significantly associated with increased hazards of sCKD after ITx. Individuals with higher GFR at the time of ITx (HR 0.92 for each ten ml/min/1.73m2 increment), receiving induction therapies (HR 0.47) or tacrolimus (HR 0.52) after ITx showed significantly lower hazards of sCKD after ITx. In adjusted analysis, sCKD development after ITx was associated with a significantly higher hazard of death (HR 6.20).
Conclusions: The incidence of sCKD after ITx is even higher than previously reported and is associated with poor survival after ITx. Modifiable risk factors for sCKD should be controlled aggressively, particularly in female and older recipients.
To cite this abstract in AMA style:Huard G, Iyer K, Moon J, Schwartz L, Doucette J, Nair V, Schiano T. Cumulative Incidence, Risk Factors for and Impact on Survival of Severe Chronic Kidney Disease After Intestinal Transplantation: Analysis of the SRTR Database [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/cumulative-incidence-risk-factors-for-and-impact-on-survival-of-severe-chronic-kidney-disease-after-intestinal-transplantation-analysis-of-the-srtr-database/. Accessed April 2, 2020.
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