Liver Recipient with Renal Dysfunction: Liver Only or Simultaneous Liver-Kidney Transplant?
University of Minnesota, Minneapolis, MN.
Meeting: 2016 American Transplant Congress
Abstract number: B179
Keywords: Kidney/liver transplantation, Liver transplantation, Mortality, Renal dysfunction
Session Information
Session Name: Poster Session B: Kidney Issue in Liver Transplantation
Session Type: Poster Session
Date: Sunday, June 12, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: The OPTN listing criteria for Simultaneous liver-kidney transplant (SLK) are not well defined. There are concerns about rising numbers of SLKs, which take kidneys away from candidates awaiting kidney transplants (tx).
Methods: We did a retrospective review of liver transplants at our center from 2004-14 and isolated 141 recipients with short-term pre-op kidney dysfunction (Serum creatinine>4 or requiring dialysis for <6 wks). Primary outcomes compared were renal non-recovery (Dialysis for >3mo after tx), 1 yr mortality, 1 yr graft failure and post-op length of stay (LOS). Multivariate analysis of age and sex adjusted 1 yr mortality of recipients was done.
Results: 114 patients received a liver transplant alone (LTA), 27 patients had SLK. Both cohorts had comparable baseline characteristics. MELD score was significantly higher in the LTA group (p<0.0001), while pre-tx HD days were significantly higher in SLK recipients (p=0.009). 4 LTA recipients and 1 SLK recipient had renal non-recovery (p=1.0). There was no significant difference in 1 yr mortality, liver graft failure or LOS between the cohorts.
| Variable | Category | LTA(n=114) | SLK(n=27) | P value |
| Age (yrs) | Mean(SD) | 52.69(10.91) | 56.33(8.98) | 0.07 |
| Sex | M/F | 73/41 | 19/8 | 0.65 |
| BMI (kg/m2) | Mean(SD) | 29.50(6.72) | 29.49(6.46) | 0.78 |
| MELD | Mean(SD) | 40.84(6.04) | 33.78(6.95) | <0.0001 |
| Donor age (yrs) | Mean(SD) | 41.55(16.87) | 41.03(15.55) | 0.88 |
| Pre-tx HD | n | 88 | 19 | 0.46 |
| Pre-tx HD days | Median | 6 | 13 | 0.009 |
| 1 year mortality | n(%) | 16(14.04) | 4(14.81) | >0.99 |
| LOS(days) | Mean(SD) | 21.27(16.05) | 19.77(14.01) | 0.49 |
| HD>3mo | n(%) | 4(3.5) | 1(3.7) | 1.0 |
| 1 year graft failure | n | 5 | 0 | 0.58 |
Age and sex adjusted multivariate analysis did not show any association of one-year mortality with type of transplant.
| Adjusting variable | OR | p value |
| None | 0.93 | 0.90 |
| MELD | 0.90 | 0.89 |
| Donor age | 0.92 | 0.90 |
| Pre-tx HD | 0.92 | 0.89 |
| Pre-tx HD days | 0.78 | 0.74 |
| Post-tx HD | 1.04 | 0.95 |
| Post-tx HD days | 0.52 | 0.47 |
There has been a decline in proportion of SLK recipients in the last 5 years (14.5%) compared to the first 5 years (24.6%).
Conclusions: Most patients with short-term (<6 wks) dialysis or AKI without dialysis do well with Liver transplant alone and do not need a simultaneous kidney transplant. The UNOS criteria for SLK need to be clearly defined. Role of early Kidney after liver transplant needs to be established for patients with renal non-recovery.
CITATION INFORMATION: Yadav K, Pruett T, Kandaswamy R, Payne W, Zhang L, Chinnakotla S. Liver Recipient with Renal Dysfunction: Liver Only or Simultaneous Liver-Kidney Transplant? Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Yadav K, Pruett T, Kandaswamy R, Payne W, Zhang L, Chinnakotla S. Liver Recipient with Renal Dysfunction: Liver Only or Simultaneous Liver-Kidney Transplant? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-recipient-with-renal-dysfunction-liver-only-or-simultaneous-liver-kidney-transplant/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress