Past literature has suggested that simultaneous liver-kidney(SLK) transplant recipients may experience a nephroprotective effect compared to kidney(Ki) alone transplant recipients. Since hepatorenal syndrome is a major cause of renal failure in cirrhotic patients, SLK recipients may be more likely to recover some native renal function v. Ki recipients. But with prolonged dialysis duration, native renal function rarely recovers regardless of renal failure cause.

Hypothesis: Prolonged pretransplant dialysis nullifies any kidney graft survival benefit in SLK v. Ki recipients.

Methods: A retrospective SRTR analysis(1987-2014) identified adult 1st time SLK and Ki recipients who shared the same donor. Recipients were stratified by dialysis duration 0-2 v. >2 years. Primary outcome was kidney 10-year death censored graft survival(DCGS). Multivariate Cox modeling was performed for the overall study cohort including the interaction term of dialysis duration & transplant type, and for subgroups by transplant type or dialysis duration.

Results: 2601 SLK and 2601 Ki were identified. Mean dialysis duration for SLK and Ki were 241 and 1385 days respectively. For dialysis 0-2 years, SLK had better kidney DCGS v. Ki(p=0.02,Fig.1A). But for dialysis >2 years, SLK trended worse kidney DCGS v. Ki (p=0.05,Fig.1B). In the multivariate model, the interaction term was significant(p=0.016), and kidney DCGS in SLK v. Ki was significantly better for dialysis 0-2 years but statistically similar for dialysis >2 years(Table 1). No difference in 1-year acute rejection was seen.

Conclusion: Our study suggests that SLK recipients lose their “nephroprotective” effect with prolonged pretransplant dialysis. This raises the question of whether recovery of some native kidney function may play an important role in kidney graft survival in SLK recipients.

CITATION INFORMATION: Casey M, Wen X, Santos A, Rehman S, Womer K. Prolonged Pre-Transplant Dialysis Duration Reverses the “Nephroprotective Effect” in Simultaneous Liver-Kidney Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).

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