Abou Diwan Elizabeth, Patel Ankit B, Cuenca Alex G, Elias Nahel, Gilligan Hannah M, Heher Eliot, Leaf David E, Wojciechowski David, Safa Kassem
American University of Beirut Medical School, Beirut, Lebanon.
Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Case Rep Transplant. 2020 Oct 5;2020:8819345. doi: 10.1155/2020/8819345. eCollection 2020.
Among patients with short bowel syndrome who commonly have kidney disease, kidney transplantation remains challenging. We describe the clinicopathologic course of a 59-year old man with short bowel syndrome secondary to Crohn's disease who underwent a deceased donor kidney transplant that was complicated by recurrent acute kidney allograft injury due to volume depletion from diarrhea, ultimately requiring the placement of permanent intravenous access for daily volume expansion at home resulting in the recovery of allograft function. Teduglutide treatment at 1.8 years post-transplant led to a dramatic decrease in diarrhea. A literature review of similar cases yielded 18 patients who underwent 19 kidney transplants. Despite high rates of complications, at the time of last follow-up (median 2.1 years [0.04-7]), 94% of the patients were still alive and 89% had functioning allografts, with a median eGFR of 37.5 [14-122] ml/min/1.73m. In conclusion, despite high rates of complications, kidney transplantation in patients with short bowel syndrome is associated with acceptable short- and midterm outcomes. Further, we report for the first time the effects of the glucagon-like peptide-2 analogue teduglutide for short bowel syndrome in a kidney transplant recipient.
在通常患有肾脏疾病的短肠综合征患者中，肾移植仍然具有挑战性。我们描述了一名59岁男性克罗恩病继发短肠综合征患者的临床病理过程，该患者接受了已故供体肾移植，因腹泻导致容量耗竭而并发反复急性肾移植损伤，最终需要在家中放置永久性静脉通路进行每日容量扩充，从而使移植肾功能恢复。移植后1.8年使用替度鲁肽治疗导致腹泻显著减少。对类似病例的文献回顾发现了18例接受19次肾移植的患者。尽管并发症发生率很高，但在最后一次随访时（中位时间2.1年[0.04 - 7年]），94%的患者仍然存活，89%的患者移植肾功能良好，中位估算肾小球滤过率为37.5[14 - 122]ml/min/1.73m²。总之，尽管并发症发生率很高，但短肠综合征患者的肾移植与可接受的短期和中期结果相关。此外，我们首次报告了胰高血糖素样肽-2类似物替度鲁肽对肾移植受者短肠综合征的影响。
