Delayed Renal Implantation Improves Survival Following Simultaneous Liver-Kidney Transplantation in High Acuity Recipients.
1Houston Methodist Hospital, Houston, TX
2David Geffen School of Medicine at UCLA, Los Angeles, CA
Meeting: 2017 American Transplant Congress
Abstract number: 426
Keywords: Graft survival, Kidney/liver transplantation, Pulsatile preservation, Renal function
Session Information
Session Name: Concurrent Session: Kidney Issues in Liver Transplantation
Session Type: Concurrent Session
Date: Tuesday, May 2, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: E451b
OBJECTIVES:
Simultaneous liver-kidney transplantation (SLKT) improves survival for liver transplant (LT) recipients with renal dysfunction (RD); however, simultaneous transplant risks KT futility in high acuity recipients. We sought to analyze effects of delayed KT through pulsatile cold perfusion pumping on SLKT outcomes.
METHODS:
Retrospective dual center analysis (UCLA [n=91], TMH [n=67]) of adults receiving SLKT from 2008-16.
| pSLKT
(N=58) |
npSLKT
(N=100) |
P-value |
|
| Lab MELD | 34 (18-46) | 35 (17-46) | ns |
| Pre-Tx ICU | 52% (30) | 37% (37) | 0.05 |
| Pre-Tx Ventilator | 38% (22) | 25% (25) | ns |
| Pre-Tx Vasopressors | 52% (30) | 20% (20) | <0.001 |
| KDRI | 1.0 (0.7-2.0) | 1.0 (0.6-2.5) | ns |
| Kidney CIT (min) | 1395 (545-2886) | 820 (300-2434) | <0.001 |
| Post-Tx LOS (days) | 23 (1-75) | 30 (1-157) | 0.03 |
| Post-Tx HD Independence | 98% (57) | 89% (89) | 0.03 |
| Kidney Primary Nonfunction | 2% (1) | 12% (12) | 0.02 |
RESULTS:
58 SLKTs (37%) underwent delayed transplant of pumped kidneys (pSLKT). 100 (63%) received non-pumped kidneys (npSLKT). Median MELD was 34 for pSLKT and 35 for npSLKT (p=ns). PreTx, pSLKT had longer ICU stay and greater vasopressor use, but were otherwise similar to npSLKT (Table1). Despite this, 1-, 3-, and 5-yr survival were significantly greater for pSLKT (p=0.04, Figure1). pSLKT recipients demonstrated a decreased PostTx length of stay (p<0.001) and KT primary nonfunction (p=0.018) compared with npSLKT (Table1).
CONCLUSIONS:
In high acuity LT recipients, delayed KT by 24 hours allows recipient hemodynamic stabilization. Kidney pumping improves survival and decreases futility. Outcomes are similar to allograft survival for KT alone, despite LT recipient acuity. This suggests allowances of SLKT allocation should continue to avoid unnecessary death following LT from ongoing RD.
CITATION INFORMATION: Lunsford K, Agopian V, Saharia A, Balough J, Mobley C, Gordon-Boroughs S, Gritsch H, Podder H, Knight R, Danovitch G, Li X, Gaber A, Busuttil R, Ghobrial R. Delayed Renal Implantation Improves Survival Following Simultaneous Liver-Kidney Transplantation in High Acuity Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Lunsford K, Agopian V, Saharia A, Balough J, Mobley C, Gordon-Boroughs S, Gritsch H, Podder H, Knight R, Danovitch G, Li X, Gaber A, Busuttil R, Ghobrial R. Delayed Renal Implantation Improves Survival Following Simultaneous Liver-Kidney Transplantation in High Acuity Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/delayed-renal-implantation-improves-survival-following-simultaneous-liver-kidney-transplantation-in-high-acuity-recipients/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress