Renal failure associated with intestinal transplantation: our experience in Spain.

BACKGROUND: Renal failure (RF) is a frequent complication in non-renal solid organ transplants. In the present study, we analyze our experience with intestinal transplants (ITx). METHODS: Between 2004 and 2012, we performed 21 ITx in 19 adult patients. Alemtuzumab was used as an induction agent followed by tacrolimus. Renal function was assessed before ITx and during the perioperative period. RESULTS: The main cause for transplants was non-resectable desmoids tumors (33.3%), followed by vascular thrombosis (19%) and others. Medical complications were frequent, especially infectious diseases, which were the most common (51%). Surgical complications were also frequent, but most of them (>50%) were mild but leading to a great number of re-operations and prolonged stays in hospital. Acute rejection is very frequent (66.6%) but mild in more than 70% of the cases. Finally, RF was very frequent (68.4%; 13/19 patients) and accounted for 15.6% of all medical complications. Causes were multiple. One patient is awaiting a kidney transplant, but no other patients need renal replacement therapy at the moment. Ileostomy closure was performed in 5 of 12 patients alive, showing improved renal function in 3 of them. CONCLUSIONS: RF is a problem in ITx and is always multifactorial. Increases in hospital stay, higher morbidity and is a cause for hospital readmission. Almost all patients had an impaired renal function when discharged. Immunosuppressants and ileostomy closure as soon as possible might prevent RF.

[Pre-emptive kidney transplant]. / Trasplante renal anticipado.

- Kidney transplant is nowadays an indisputable treatment, which has been shown to improve both the quantity and quality of life of patients with end-stage kidney disease (Strength of Recommendation A). - Time on dialysis is one of the factors associated with poor prognosis for graft and patient survival (Strength of Recommendation B). - Early kidney transplant avoids the inconveniences caused by dialysis techniques and the expenditure generated by them (Strength of Recommendation B). - Early kidney transplant from a living or cadaver donor has shown better graft and recipient survival results than kidney transplant performed in patients on dialysis (Strength of Recommendation B). - Early kidney transplant should be offered to all patients who are candidates for a living donor kidney. In the case of a cadaver donor, early kidney transplant can be an ideal option for all candidates, but in particular for children and patients with diabetic nephropathy. However, it should not be forgotten that there is a limited supply of cadaver donors (Strength of Recommendation B). - In patients over 65 years of age, kidney transplant should be considered as a treatment option since it increase life expectancy compared to dialysis (Strength of Recommendation B). - We should promote strategies to combat the shortage of organs (promote living donor transplant, use of suboptimal donors, asystolic donors, etc.) and so be able to consider the option of early kidney transplant (Strength of Recommendation C). - The ideal time for patients with chronic kidney disease to be included on the waiting list for a kidney transplant should be when their glomerular filtration rate is less than 15-20 ml/min and we can foresee that the time for their inclusion in dialysis will no extend beyond 1 to 2 years (Strength of Recommendation C). - We should not forget that the time on the waiting list for a kidney transplant is exactly the same for all patients with chronic kidney disease whether or not they are on dialysis (Strength of Recommendation C). In conclusion, we can state that there is a sufficiently solid scientific basis for attempting that patients receive the option of a kidney transplant before their inclusion in dialysis.

[Determination of factors conditioning adherence and accomplishment of renal protection diet in patients with chronic renal failure: pilot study for the elaboration of a dietary guideline]. / Determinación de los factores condicionantes en la adhesión y cumplimiento de la dieta de protección renal en pacientes con insuficiencia renal crónica: estudio previo para la elaboración de una guía dietética.

There are seldom studies on dietary behavior of patients with chronic renal failure (CRF). The aim of this study has been to know, by means of a previously validated questionnaire, which are the psycho-sociocultural factors that affect, and to what extent, assumption and adherence the dietary therapy while determining the degree of disease perception and several factors related with it. The study population is comprised by 81 patients from the nephrology clinic of the "12 de Octubre" Hospital of Madrid, with CRF in a pre-dialysis status. Seventy-seven point seventy-four percent answered "well" or "very well" to questions relating to disease knowledge and perception. Emotional and auto-management factors have little relevance according to 69.87% of patients. Fifty-nine point twenty-six percent feel a high level of familial support, and 35.77% alters dietary behavior when environmental conditions change. Most of the interviewees (87.65%) do not have difficulties finding the prescribed foods, and 70.37% considers their cost is not excessive. For almost half of the patients (48.76%), renal protection diet represents a variation in their dietary habits, a similar percentage expresses difficulty with elaboration. Food palatability is not a problem in 67.90% of the cases. Fifty-one point twenty-four percent does not perceive difficulty with cooking procedures. Seventy point ninety-nine percent feels support in one way or the other, by health care staff, although just 56.79% reports that the diet has not been explained to them. Only 18.51% questions the diet effectiveness as regards to their disease course. As for the gender variable, there were significant differences (p < 0.05), with a higher influence on men, in sections relating to disease knowledge, and influence of apathy and family support, the women those having the highest scores for food management, diet transgression at family meetings, and less information received about the prescribed diet. As for family support, there are significant differences only by age groups, patients aged more than 65 years being those feeling more this psychological support. The group of patients with a creatinine clearance less than 25 mL/min is the one expressing less categorically their appreciation on diet effectiveness. There are factors in which significant difficulty percentages are observed and that may induce diet transgression, in some cases without the patient being completely aware of, such as environmental changes, change in traditional habits, the degree of diet explanation, the organoleptic characteristics, and the lack of knowledge of appropriate cooking procedures. All these indicators confirm the need for enhancing nutritional education of these patients and their family environment, also showing the need for a nutritional intervention that completely supports patients in the process of adaptation and maintenance of their new dietary habit.