Kidney allograft survival outcomes in combined intestinal-kidney transplant

An analysis of the UNOS/OPTN database 2000-2014

Irfan Moinuddin, Muhammad Sohail Yaqub, Tim Taber, Muhammad Mujtaba, Asif Sharfuddin

Research output: Contribution to journalArticle

Abstract

Background and objectives: Intestinal transplants carry a high morbidity/mortality. Kidney allograft outcomes after combined intestinal (IT) with kidney transplant (CIKT) remain largely uninvestigated. Materials and methods: The UNOS STAR database was queried to identify all such combined organ transplants from 2000 to 2015. Results: Out of a total 2215 (51.4% peds vs 48.6% adults) intestinal transplants, 111 (5.0%) CIKT were identified (32.4% peds vs 67.6% adults). Over the study period of CIKT, a total of 45.9% of these cases died with a functioning kidney graft. DGF rate was 9.0%. The 1-year reported kidney acute rejection rate was 6.3%. For the entire CIKT population over the entire study era, the 1-, 3-, and 5-year unadjusted kidney graft survival was 57%, 39%, and 34%, while death-censored kidney graft survival was 93%, 90%, and 86%, respectively. Overall conditional 5-year kidney graft survival (defined as 1-year kidney graft survival) was 58%. Overall, patient survival was significantly lower in recipients of CIKT compared to intestinal transplant (IT) (P < .005); However, the 5-year conditional (1 year kidney graft) patient survival in adults was not significantly different between IT and CIKT overall (P = .194). Conclusions: Kidney allograft survival is primarily dependent on 1-year patient survival. Guidelines regarding allocation of kidney allografts in CIKT need to take into consideration utility and urgency.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

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Allografts
Databases
Transplants
Kidney
Graft Survival
Survival
Guidelines
Morbidity
Mortality

Keywords

  • Allograft
  • Combined
  • Intestine
  • Kidney
  • Multivisceral
  • Rejection
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Kidney allograft survival outcomes in combined intestinal-kidney transplant : An analysis of the UNOS/OPTN database 2000-2014. / Moinuddin, Irfan; Yaqub, Muhammad Sohail; Taber, Tim; Mujtaba, Muhammad; Sharfuddin, Asif.

In: Clinical Transplantation, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background and objectives: Intestinal transplants carry a high morbidity/mortality. Kidney allograft outcomes after combined intestinal (IT) with kidney transplant (CIKT) remain largely uninvestigated. Materials and methods: The UNOS STAR database was queried to identify all such combined organ transplants from 2000 to 2015. Results: Out of a total 2215 (51.4{\%} peds vs 48.6{\%} adults) intestinal transplants, 111 (5.0{\%}) CIKT were identified (32.4{\%} peds vs 67.6{\%} adults). Over the study period of CIKT, a total of 45.9{\%} of these cases died with a functioning kidney graft. DGF rate was 9.0{\%}. The 1-year reported kidney acute rejection rate was 6.3{\%}. For the entire CIKT population over the entire study era, the 1-, 3-, and 5-year unadjusted kidney graft survival was 57{\%}, 39{\%}, and 34{\%}, while death-censored kidney graft survival was 93{\%}, 90{\%}, and 86{\%}, respectively. Overall conditional 5-year kidney graft survival (defined as 1-year kidney graft survival) was 58{\%}. Overall, patient survival was significantly lower in recipients of CIKT compared to intestinal transplant (IT) (P < .005); However, the 5-year conditional (1 year kidney graft) patient survival in adults was not significantly different between IT and CIKT overall (P = .194). Conclusions: Kidney allograft survival is primarily dependent on 1-year patient survival. Guidelines regarding allocation of kidney allografts in CIKT need to take into consideration utility and urgency.",
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