Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

Shunji Nagai; Mohamed Safwan; Kelly Collins; Randolph E Schilke; Michael Rizzari; Dilip Moonka; Kimberly Brown; Anita Patel; Atsushi Yoshida; Marwan Abouljoud

doi:10.1111/tri.13275

Liver alone or simultaneous liver-kidney transplant? Pretransplant chronic kidney disease and post-transplant outcome - a retrospective study

Transpl Int. 2018 May 2. doi: 10.1111/tri.13275. Online ahead of print.

Affiliations

¹ Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA.
² Gastroenterology, Henry Ford Hospital, Detroit, MI, USA.
³ Nephrology, Henry Ford Hospital, Detroit, MI, USA.

PMID: 29722081
DOI: 10.1111/tri.13275

Abstract

The new Organ Procurement and Transplant Network/United Organ Sharing Network (OPTN/UNOS) simultaneous liver-kidney transplant (SLK) policy has been implemented. The aim of this study was to review liver transplant outcomes utilizing the new SLK policy. Liver transplant alone (LTA) and SLK patients between 2009 and 2015 were reviewed. Graft survival and post-transplant kidney function were investigated among LTA patients meeting the chronic kidney disease (CKD) criteria of the new policy (LTA-CKD group). To validate our findings, we reviewed and applied our analysis to the OPTN/UNOS registry. A total of 535 patients were eligible from our series. The LTA-CKD group (n = 27) showed worse 1-year graft survival, compared with the SLK group (n = 44), but not significant (81% vs. 93%, P = 0.15). The LTA-CKD group significantly increased a risk of post-transplant dialysis (odds ratio = 5.59 [95% CI = 1.27-24.7], P = 0.02 [Ref. normal kidney function]). Post-transplant dialysis was an independent risk factor for graft loss (hazard ratio = 7.25, 95% CI = 3.3-15.91, P < 0.001 [Ref. SLK]). In the validation analysis based on the OPTN/UNOS registry, the hazard of 1-year-graft loss in the LTA-CKD group (n = 751) was 34.8% higher than the SLK group (n = 2856) (hazard ratio = 1.348, 95% CI = 1.157-1.572, P < 0.001). Indicating SLK for patients who meet the CKD criteria may significantly improve transplant outcomes.

Keywords: Organ Procurement and Transplant Network; United Organ Sharing Network; chronic kidney disease; hepatorenal syndrome; liver-kidney transplantation.