Renal function and histology in children after small bowel transplantation

Authors

  • Olivia Boyer,

    1. Pediatric Nephrology Unit, Reference Center for Hereditary Renal Diseases in Children and Adolescent (MARHEA), Paris, France
    2. Inserm U983, Paris, France
    3. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
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    • The two-first authors are equal contributors.

  • Cristian Noto,

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
    2. Pediatric Hepato-Gastroenterology-Nutrition Unit and Reference Center for Rare Digestive Diseases in Children (MaRDI), Paris, France
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    • The two-first authors are equal contributors.

  • Natacha Patey-Mariaud De Serre,

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
    2. Pathology Unit, Necker-Enfants Malades Hospital, Paris, France
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  • Marie-Claire Gubler,

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
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  • Michèle Dechaux,

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
    2. Physiology Unit, Necker-Enfants Malades Hospital, Paris, France
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  • Olivier Goulet,

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
    2. Pediatric Hepato-Gastroenterology-Nutrition Unit and Reference Center for Rare Digestive Diseases in Children (MaRDI), Paris, France
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  • Patrick Niaudet,

    1. Pediatric Nephrology Unit, Reference Center for Hereditary Renal Diseases in Children and Adolescent (MARHEA), Paris, France
    2. Inserm U983, Paris, France
    3. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
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  • Florence Lacaille

    1. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Descartes Sorbonne Paris-Cité University, Paris, France
    2. Pediatric Hepato-Gastroenterology-Nutrition Unit and Reference Center for Rare Digestive Diseases in Children (MaRDI), Paris, France
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Florence Lacaille, Hepato-Gastroenterology-Nutrition Unit, Necker-Enfants malades Hospital, 149 rue de Sèvres, 75015 Paris, France
Tel.: +33 144 494 412
Fax: +33 144 492 501
E-mail: florence.lacaille@nck.aphp.fr

Abstract

Boyer O, Noto C, Patey-Mariaud De Serre N, Gubler M-C, Dechaux M, Goulet O, Niaudet P, Lacaille F. Renal function and histology in children after small bowel transplantation.

Abstract:  CKD is a frequent long-term complication after SBTx. CNIs are a well-known factor, but probably not the only cause. We assessed the incidence, risk factors, and severity of CKD in 27 children with SBTx (15 combined liver/SBTx) and prednisone/TAC-based maintenance immunosuppression. Median follow-up was seven yr (3–21). A renal biopsy was performed in 14 patients, 1–18 yr post-SBTx. A reduced GFR was observed in 17 children (63%) during the follow-up with none requiring dialysis. CNI toxicity was observed in 11/14 biopsies, as early as two yr post-transplant, and could occur with a normal mGFR. The dose of TAC was reduced by 50% in 13 patients with CKD and/or significant kidney histological lesions, and six were also given MMF. This led to a significant improvement in renal function: mGFR normalized in eight patients and improved or stabilized in five. No rejection occurred. At last follow-up, 37% had CKD stage 2 and 15% had CKD stage 3. In conclusion, CKD is frequent in children after SBTx and probably multifactorial. Less nephrotoxic immunosuppressive protocols may improve mGFR and should be further considered. The kidney histology helps in designing personalized immunosuppression strategies for patients.

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