Avoiding Futility in Simultaneous Liver-Kidney Transplantation (SLKT): Analysis of 331 Consecutively Listed Patients

K. Lunsford, A. Bodzin, D. Reino, A. Zarrinpar, F. Kaldas, H. Gritsch, J. Veale, G. Lipshutz, D. Farmer, G. Danovitch, H. Yersiz, J. Hiatt, R. Busuttil, V. Agopian.

Departments of Surgery, Urology, and Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Meeting: 2015 American Transplant Congress

Abstract number: 57

Keywords: Graft failure, Graft function, Kidney/liver transplantation, Multivariate analysis

Session Information

Session Name: Concurrent Session: Optimizing Renal Outcomes in Liver Transplantation

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 2:39pm-2:51pm

Location: Room 118-AB

Without well-established listing guidelines for SLKT, MELD prioritization of liver recipients with renal dysfunction potentially risks scarce renal allografts. We sought to evaluate short-term predictors of renal allograft futility (RAF), defined as patient death or hemodialysis (HD) at 3mo following SLKT.

METHODS:

Retrospective single-center multivariate analysis of adult patients listed for SLKT from 1/04-6/14 to evaluate kidney delayed graft function (kDGF, HD>7d) and RAF.

RESULTS:

Of 331 listed SLKT patients, 171 (52%) expired awaiting SLKT, 145 (44%) underwent SLKT, and 15 (5%) underwent liver transplant (LT) alone. Of 145 SLKTs, 57 (39%) and 29 (20%) experienced kDGF and RAF, respectively. Survival was significantly superior in SLKTs not experiencing RAF (1-, 3-, and 5- year survival 93, 84, and 84% with non-RAF versus 17, 14, and 14% with RAF, p<0.001). Compared to non-futile SLKTs, RAF patients had higher acuity with greater MELD, length of preTx HD and hospitalization, worse intraop base deficit (BD), greater frequency of female donors, and longer kidney cold ischemia (kCIT).

Table 1: Univariate analysis of factors associated with SLKT futility
	Non RAF (N=116)		RAF (N=29)		p-value
	Mean	STD	Mean	STD
Lab MELD	33.3	7.7	36.2	5	0.02
kCIT (min)	827	329	1089	579	0.03
Worst IntraOp BD	-8.7	5.1	-10.5	4.4	0.04
PreTx LOS (days)	18.6	19.0	30.7	19.7	0.02
PostTx HD (days)	8.1	13.8	88.4	110	<0.001

	%	N	%	N
Female Donor	66.4	77	44.8	13	0.03
In-Hospital Mortality	0.8	1	72.4	21	<0.001
PostTx HD	45.7	53	82.8	24	<0.001
kDGF	30.2	35	82.8	22	<0.001
Kidney Nonfunction	0	0	65.5	19	<0.001

Futile LT (in-hospital mortality) accounted for 21/29 (72%) of RAF. Multivariate predictors of RAF included female donors, MELD, HD duration, kCIT, and intraop BD.

Table 2: Multivariate analysis of factors associated with SLKT futility
	Odds Ratio	95% CI	p-value
Lab MELD (per point increase)	1.102	1.013-1.200	0.02
PreTx HD (per day)	1.001	1.000-1.001	0.05
kCIT (per min)	1.003	1.001-1.005	0.002
IntraOp BD (per unit)	1.124	1.000-1.266	0.05
Female Donor	2.790	0.997-7.812	0.05

CONCLUSIONS:

With 20% short-term loss of transplanted kidneys in SLKT, our data strongly suggest that renal transplantation should be deferred in liver recipients at high risk for RAF. Consideration for kidney allocation variance to allow for delayed renal transplant following LT may prevent loss of scarce renal allografts.

To cite this abstract in AMA style:

Lunsford K, Bodzin A, Reino D, Zarrinpar A, Kaldas F, Gritsch H, Veale J, Lipshutz G, Farmer D, Danovitch G, Yersiz H, Hiatt J, Busuttil R, Agopian V. Avoiding Futility in Simultaneous Liver-Kidney Transplantation (SLKT): Analysis of 331 Consecutively Listed Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/avoiding-futility-in-simultaneous-liver-kidney-transplantation-slkt-analysis-of-331-consecutively-listed-patients/. Accessed November 23, 2024.

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