Simultaneous Liver/Kidney transplantation involves significant potential stress for the kidney graft. A surgeon needs to decide whether to place the kidney immediately to minimize cold ischemia time or to delay the kidney transplant to wait for a better recipient environment.

We examined whether pump preservation and delayed kidney transplantation provided measurable outcome improvements as compared to a strategy of immediate implantation to minimize cold ischemia. 1 year kidney graft survival was the primary outcome studied. Secondary outcomes were dialysis within the first week, Creatinine at discharge and most recent serum Creatinine.

To more thoroughly analyze this population the SRTR liver and kidney recipient databases were merged using the unique patient identifier thereby giving access to both liver and kidney variables. 4035 Liver/Kidney recipients were analyzed. Overall, there appeared to be no overall advantage for pump preservation of the kidney as compared to cold storage for any of the outcome variables measured. 1 year kidney graft survival was superior when kidney cold ischemia time was less than 12hrs. In order to analyze the impact of delayed vs. immediate kidney implantation of the kidney, the variable dCIT (the difference in CIT between liver and kidney) was developed. Using dCIT less than 10 hours to represent immediate implantation, 4 study groups were created representing immediate implantation/cold storage, delayed implantation/cold storage, immediate implantation/pump and delayed implantation/pump. Analysis of 1 year kidney graft survival demonstrated the best results when the kidney was immediately implanted after the liver for both pumped and ice preserved grafts. When the kidney implantation was delayed pump preservation provided a small advantage over ice alone.

CITATION INFORMATION: Halldorson J, Rayhill S. Immediate vs. Delayed Kidney Implantation Is Associated with Improved Kidney Graft Survival in Combined Liver-Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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