Effect of Hypothermic Pulsatile Machine Perfusion on Kidney Delayed Graft Function in Simultaneous Liver-Kidney Transplantation: A Single Center Study.
1Surgery, University of California, Los Angeles, CA
2Urology, University of California, Los Angeles, CA
Meeting: 2017 American Transplant Congress
Abstract number: 430
Keywords: Graft function, Kidney/liver transplantation, 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: 3:30pm-3:42pm
Location: E451b
OBJECTIVE: Assessment of risk factors correlated with the development of kidney delayed graft function (kDGF) among recipients of simultaneous liver-kidney transplant (SLKT).
BACKGROUND: Renal dysfunction occurs in about 20% of patients with end stage liver disease who are awaiting orthotopic liver transplantation (OLT). Patients who undergo SLKT have better outcomes relative to those who receive OLT alone in terms of patient and graft survival. Nonetheless, the development of kDGF has been a challenging problem after SLKT with a reported incidence up to 40%. Given the scarcity of renal allografts, it is crucial to minimize the development of kDGF among SLKT recipients.
PATIENTS AND METHODS: All patients who underwent SLKT in the period from January 1, 2004 to November 30, 2016 were reviewed to assess predictors of kidney delayed graft function (KDGF). Starting in October 2015, our center initiated a program of placing all renal allografts allocated to SLKT recipients on HPMP.
RESULTS: During the period of the study, 172 patients underwent SLKT. Three patients were excluded from the analysis due to missing kidney function data. Univariate analysis of preoperative recipient and donor factors is shown in Table 1. Variables with significance at P<0.2 were included in multivariate regression analysis to avoid missing important factors. It was found that patients who developed kDGF had significantly higher preoperative MELD score (OR 1.095, P=0.001), longer length of preoperative ICU stay (OR 1.015, P=0.044), received allografts from donors with history of HTN (OR 3.551, P=0.006), and the kidneys were preserved using cold static storage (not on HPMP pump, OR 3.189, P=0.033).
| Table: Multivariate Logistic Regression Analysis for the Development of kGDF | |||
| OR | 95% CI | P-value | |
| Donor History of Hypertension | 3.551 | 1.450 – 8.699 | 0.006 |
| Physiologic MELD at time of SLKT | 1.095 | 1.039 – 1.153 | 0.001 |
| Recipient Length of Preoperative ICU stay (days) | 1.015 | 1.000 – 1.029 | 0.044 |
| Kidneys Pumped on HPMP | 3.189 | 1.099 – 9.251 | 0.033 |
CONCLUSIONS:
Hypothermic pulsatile machine perfusion of kidney allografts plays a key-role in preventing kDGF among patients listed for SLKT.
CITATION INFORMATION: Korayem I, Gritsch H, Veale J, Lipshutz G, Agopian V, Kaldas F, Farmer D, Busuttil R, Zarrinpar A. Effect of Hypothermic Pulsatile Machine Perfusion on Kidney Delayed Graft Function in Simultaneous Liver-Kidney Transplantation: A Single Center Study. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Korayem I, Gritsch H, Veale J, Lipshutz G, Agopian V, Kaldas F, Farmer D, Busuttil R, Zarrinpar A. Effect of Hypothermic Pulsatile Machine Perfusion on Kidney Delayed Graft Function in Simultaneous Liver-Kidney Transplantation: A Single Center Study. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/effect-of-hypothermic-pulsatile-machine-perfusion-on-kidney-delayed-graft-function-in-simultaneous-liver-kidney-transplantation-a-single-center-study/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress