Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ GENERAL INDICATIONS FOR INTESTINAL TRANSPLANTATION1–3 ++ Intestinal failure (IF) with inability to continue parenteral nutrition (PN) PN-induced liver injury or failure Thrombosis of the majority of central veins necessary for PN access Recurrent central line sepsis Inability to maintain adequate hydration/nutrition despite PN Acute intestinal infarction Significant morbidity related to IF Intraabdominal desmoid tumors +++ BACKGROUND: SIMULTANEOUS KIDNEY–INTESTINAL TRANSPLANT ++ Organ Procurement and Transplantation Network data (January 1988–August 2020)4 Thirty-nine simultaneous kidney–intestinal transplants in the United States Majority of available data does not separate kidney–intestine alone and kidney–multivisceral transplantation (MVT) Only ~25% of kidney–intestinal transplants do not include additional organ5 73.9% includes simultaneous liver 75.7% includes simultaneous pancreas Adult recipient characteristics (kidney–intestine alone/MVT/modified MVT)5 UNOS data 2000–2015 Mean recipient age: ~34 years and 55% male 26.1% on dialysis at time of transplant 21.3% dependent on PN 27.9% intravenous fluid dependent Outcome data detailed in Chapter 60 “Simultaneous kidney-multivisceral transplant” Common indications/consideration for simultaneous transplant detailed in Chapter 60 “Simultaneous kidney-multivisceral transplant” rarer indications provided later +++ RENAL FAILURE AND INTESTINAL TRANSPLANTATION ++ Among adult intestinal transplant recipients in the United States (56.6% intestine alone):6 Severe chronic kidney disease (CKD) (CKD stage 4 or 5 or end-stage renal disease [ESRD] requiring dialysis or transplant) Cumulative 1-year and 10-year incidence 3.2% and 54.1%, respectively Risk factors for severe CKD after transplantation: Female gender Increased age Development of diabetes mellitus Acute cellular rejection Intestinal graft failure Catheter-related sepsis as indication for intestinal transplantation Majority of intestinal transplant recipients have excellent baseline glomerular filtration rate in this study +++ SPECIFIC CASE EXAMPLES OF KIDNEY–INTESTINE (ISOLATED) TRANSPLANTATION ++ Secondary hyperoxaluria:7 Extensive small bowel resections related to diseases such as volvulus and inflammatory bowel disease Excess intraluminal free fatty acids → decreased binding of oxalate and calcium Uncomplexed oxalate absorbed in large intestine → calcium oxalate complex precipitates in the kidneys → ESRD Simultaneous intestine–kidney transplant addresses renal failure and underlying cause Literature cites cases of recurrent renal failure when kidney transplant is performed alone in these situations8 Encapsulating peritoneal sclerosis (EPS)9 Complication of peritoneal dialysis Surgical management with stripping, strictureplasty, and enterolysis can become risky in the most advanced cases Combined kidney–intestinal transplant has been performed for a patient with EPS and history of kidney transplant with graft failure ++ KEY POINTS Simultaneous kidney–intestine (alone) transplantation is exceedingly rare but can be performed when indications for both are met. Much of the outcome data is combined with data from simultaneous kidney–MVT. Expert centers should be consulted when the potential need for this transplantation exists. ++ REFERENCES +1. +Kaufman SS, Avitzur Y, Beath SV, et al. new insights into the indications for intestinal transplantation: consensus in the year 2019. Transplantation. 2020;104:937–946. [PubMed: 31815899] +2. +Sudan D. The current state of ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.