Background: Recent changes in the allocation policy established by UNOS created a competitive algorithm that facilitates the placement of kidneys in liver transplant recipients that develop end stage renal disease (ESRD). Little is known about how the kidney quality impacts liver transplant outcomes. In this study we examined graft and patient survival for kidney after liver (KAL) transplant patients and liver transplant patients (LTA) according to liver donor risk index (LDRI) and kidney donor profile index (KDPI).

METHODS: We queried the SRTR database 2000-2017 for LTA patients on the kidney waitlist and KAL patients, and subdivided according to the calculated LDRI: ≤1.1, >1.1-1.6, >1.6. KAL cohorts were subdivided according to KDPI: <20, 20-85, >85%. Kaplan-Meier survival analysis and log-rank tests were used to compare survival distributions on respective cohorts.

Results: 2044 ESRD patients listed for a kidney transplant met criteria: 1416 LTA, 626 KAL. Demographics were similar between both. The 3-, 5- and 10- year patient survival was 85, 77 and 50% for LTA; and 99, 97 and 83% for KAL (p<0.001). Liver graft survival was also superior for KAL compared to LTA (92% vs 70% after 5 years, p<0.001). LTA cohorts with lower LDRI values are associated with superior patient and graft survival (p<0.001). However, KAL patients with KDPI<20% have significantly greater 3-, 5-, and 10- year liver (99, 95, 62%) and kidney (94, 79, 15%) graft survival rate (p<0.01). Kidney graft survival was significantly worse for KDPI>85% (P=0.004). To evaluate the impact of KDPI in patients with similar LDRI, we divided the KAL cohort according to LDRI. We observed similar patient, liver and kidney graft survival for KDPI <20, 20-85, and >85% for LDRI <1.6 and ≥1.6, suggesting lack of synergistic interaction between LDRI and KDRI in KAL recipients.

Conclusion: Patient and death censored liver graft survival is significantly lower in patients that do not have access to kidney transplantation, and this effect is exacerbated for those that received a lower quality LDRI. There is a direct correlation between quality of the kidney and expected patient survival for those recipients of a KAL. The quality of the kidney is also an important factor to predict kidney and liver graft survival. The confirmation of our results with prospective data will allow us to create a better allocation algorithm toward maximizing utility of limited resources in the future.

CITATION INFORMATION: Reyes J., Eerhart M., Danobeita J., Chlebeck P., Zitur L., Fernandez L. Kidney Quality Influences Patient and Graft Survival in Liver Transplant Recipients with End Stage Renal Disease Am J Transplant. 2017;17 (suppl 3).

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