Outcomes of Simultaneous Liver-Kidney Transplantation from DCD Organ Donors
Duke University Medical Center, Durham, NC
Clinical Trials and Consulting Services, Cincinnati, OH
Meeting: 2013 American Transplant Congress
Abstract number: 455
Simultaneous liver-kidney transplantation (SLKT) is being performed with greater frequency in the United States. Due to the shortage of available donors, organs obtained after cardiac death (DCD) are being increasingly considered for SLKT. Few studies have documented outcomes in patients undergoing SLKT with DCD organs.
Objective: To characterize national outcomes of SLKT with DCD organs and compare them to SLKT with organs from brain-dead (BD) donors.
Methods: The OPTN/UNOS database was used to examine donor, recipient, and transplant-related characteristics and graft outcomes for 100 consecutive adult SLKTs with DCD organs from 11/2001 – 5/2011. Comparisons were made to 2,950 adult SLKTs with BD organs.
Results: An increasing number of SLKTs were performed over the study time period. In 2010, a total of 375 SLKTs were performed (4.5% DCD) compared to 198 in 2002 (1.5% DCD). Median follow-up was 4 years. Characteristics of the two cohorts are shown in Figure 1. SLKTs with DCD organs were less likely to be transplanted for HCV and more likely to be transplanted for alcoholic cirrhosis and fatty liver disease. Donor age was significantly lower for DCD transplants. MELD score was significantly lower for DCD transplants while the KDRI was similar between cohorts. Fewer DCD recipients had a previous liver transplant. More DCD patients had delayed kidney graft function (DGF). Patient survival (unadjusted) at 4-years post-SLKT was 64% for DCD vs. 73% for BD (hazard ratio [HR] =1.61; 95% confidence interval [CI] =1.12-2.30; p=0.009). Kidney and liver graft survival (unadjusted) at 4-years post-SLKT was 54% and 53% for DCD transplants vs. 68% and 68% for BD (HR for kidney failure=1.50; 95% CI=1.07-2.09; p=0.017 and HR for liver failure=1.65; 95% CI=1.20-2.28; p=0.002).
Conclusions: SLKTs with DCD organs are associated with an increased risk of patient death and graft failure despite the fact that DCD patients have a lower preoperative risk profile. Efforts should be made to optimize donor and patient selection to improve clinical outcomes with DCD organs.
To cite this abstract in AMA style:
Barbas A, Irish W, Castleberry A, Ravindra K, Collins B, Sudan D, Vikraman D. Outcomes of Simultaneous Liver-Kidney Transplantation from DCD Organ Donors [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/outcomes-of-simultaneous-liver-kidney-transplantation-from-dcd-organ-donors/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress