Abstract: SA-PO0980
Multifactorial Kidney Transplant Failure in a Patient with Short-Bowel Syndrome
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Starr, Tyler Chazan, UMass Memorial Health, Worcester, Massachusetts, United States
- Le, Cindy, UMass Memorial Health, Worcester, Massachusetts, United States
- Weatherly, Henry, UMass Memorial Health, Worcester, Massachusetts, United States
- Aamir, Nawal, UMass Memorial Health, Worcester, Massachusetts, United States
- Vanguri, Vijay K., UMass Memorial Health, Worcester, Massachusetts, United States
- White, William, UMass Memorial Health, Worcester, Massachusetts, United States
- Fan, Pang-Yen, UMass Memorial Health, Worcester, Massachusetts, United States
Introduction
Short bowel syndrome (SBS) is associated with acute and chronic renal failure. Mechanisms include episodes of volume depletion from steatorrhea and enteric hyperoxaluria with consequent nephrocalcinosis and nephrolithiasis. While malabsorption has been found not to affect immunosuppressive agents, ongoing hyperoxaluria and volume depletion put transplant recipients with SBS at increased risk for allograft failure as demonstrated in this case.
Case Description
A 69 year old woman with SBS from recurrent small bowel resections developed ESRD attributed to numerous episodes of diarrhea and volume depletion. She underwent a dual deceased donor kidney transplant in Jan, 2024. Initial allograft function (Cr 0.9-1) was impacted by several episodes of AKI due to volume depletion with ongoing diarrhea (Cr 1.6-3.6). A 6 month post transplant biopsy showed no signs of rejection. Tacrolimus levels were subtherapeutic. The patient was found to have CMV viremia. A repeat biopsy in Dec 2024 for further decline in kidney function showed no acute rejection, instead demonstrated acute tubular injury with focal intraluminal calcium oxalate precipitate. After further allograft decline, she began HD 11 months post transplantation.
Discussion
This patient’s transplant likely failed due to a combination of episodic volume depletion despite use of antidiarrheals, CMV viremia, & oxalate deposition. Aggressive and early volume resuscitation efforts for hypovolemia are indicated in this population. Unlike other case reports, this patient’s tacrolimus levels were continuously subtherapeutic; although rapid bowel transit times can affect medication absorption, the low tacrolimus levels did not lead to rejection in this case. Mitigating hyperoxaluria levels is paramount in this population to prevent nephrocalcinosis. Previous studies have shown the benefit of diet modifications before and after transplant to reduce oxaluria. Teduglutide, a GLP-2 analog, has shown benefit in treating both SBS and its associated kidney failure in post transplant patients.