Abstract

Kidney transplantation in patients with inflammatory bowel diseases (IBD): analysis of transplantation outcome and IBD activity

Grupper A1,2, Schwartz D2, Baruch R1,2, Schwartz IF2, Nakache R1, Goykhman Y1, Katz P1, Lebedinsky A1, Nachmany I1, Lubezky N1, Aouizerate J1, Shashar M2,3, Katchman H1,4. Transpl Int. 2019 Feb 21. doi: 10.1111/tri.13415. [Epub ahead of print]

 
     

Author information

Organ Transplantation Unit, The Surgical Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Department of Nephrology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Renal Section, Sanz Medical Center, Laniado Hospital, Netanya, Israel.

Department of Gastroenterology, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Abstract

Inflammatory bowel diseases (IBD) is a systemic disorder with possible renal involvement, yet data regarding the outcome of kidney transplantation (KT) in those patients, and IBD course post KT, are scarce. In this retrospective analysis, we studied the outcome of 12 IBD kidney recipients (seven Crohn's disease, five ulcerative colitis; primary kidney disease was IgA nephropathy in five, polycystic disease in four), compared to two control groups: matched controls and a cohort of recipients with similar kidney disease. During a follow-up period of 60.1 (11.0-76.6) months (median, interquartile range), estimated 5-year survival was 80.8 vs. 96.8%, with and without IBD, respectively (P = 0.001). Risk of death with a functioning graft was higher with IBD (HR = 1.441, P = 0.048), and with increased age (HR = 1.109, P = 0.05). Late rehospitalization rate was higher in IBD [incidence rate ratio = 1.168, P = 0.030], as well as rate of hospitalization related to infection [1.42, P = 0.037]. All patients that were in remission before KT, remission was maintained. Patients that were transplanted with mild or moderate disease remained stable or improved with Infliximab or Adalimumab treatment. In conclusion, IBD is associated with an increased risk of mortality, hospitalization because of infection and late rehospitalization after KT. Clinical course of IBD is stable after KT.

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