BACKGROUND: Data from United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network (OPTN) reveals that living related small bowel transplant (LRSMT) in children, age less than 5 years, has been performed only 5 patients since 1988 - 2004. From these national data, 4/5 LRSMT were done at The University of Illinois Medical Center. In this study, we present renal function in this group of patients.METHODS: Retrospective review of renal function was done in 3 patients: 4 LRSMT (1 patient underwent retransplant). Mean aged at LRSMT was 2.31±1.5 years (1–4 years). Mean follow up period was 11.5 ± 8.3 months (4–21 months). All patients had underlying gastroschisis and short bowel syndrome. Immunosuppressive regimen included tacrolimus and steroid therapy. Serum electrolyte, glomerular and tubular functions were measured at 1, 3, 6, 9,12 and 18 months after transplant. Creatinine clearance (CrCl) was estimated by Schwartz formula and tubular functions were estimated by calculating fractional excretion of sodium (FENa, normal 0.2.RESULTS: Patient survival was 100 %. One patient lost graft secondary to PTLD at 4 months post LRSMT and underwent combined liver-small bowel transplant 8 months later. CrCl at 1, 3, 6, 9,12 and 18 months was 92.2±16, 98.1±25, 95.2±5, 108.5±2, 112.5 (n=1), and 113.9 (n=1) cc/min/1.73 m2 respectively. Proteinuria and tubular dysfunctions were observed after LRSMT and gradually improve. (Uprot/Cr = 1.49 ±1.0, FENa = 2.3±0.9 %, UCa/Cr = 0.20± 0.2, FEMg = 15.7±7.8 %, and TRP = 76.6±19.3 % at 1 month and Uprot/Cr = 1.27± 0.7, FENa = 1.1±1.0 %, UCa/Cr = 0.11±0.1,FEMg = 13.8±11.4 %, and TRP = 87.0±17.1 % at 3 months). All patients had renal tubular acidosis, hypocalcemia, hypomagnesemia and hypophosphatemia and received bicarbonate, calcium, magnesium and phosphorus supplement. Tacrolimus level at 1, 3, 6, 9, 12 and 18 months was 17.0 ± 2, 9.6 ± 3, 11.7 ± 1, 12.8 ± 1, 12.5 (n=1) ng/ml respectively.CONCLUSION: Abnormal glomerular, tubular function and electrolyte imbalance was observed after LRSMT especially in the early phase. Serial monitoring of renal function and long term follow up is necessary in this patient group.
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