Predictors of Delayed Kidney Graft Function Following Combined Liver and Kidney Transplantation

P. Vincenzi¹, J. Gaynor², R. Vianna³, G. Ciancio³

¹General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy, ²General Surgery, Miami Transplant Institute, Miami, FL, ³Transplant Surgery, Miami Transplant Institute, Miami, FL

Meeting: 2022 American Transplant Congress

Abstract number: 1069

Keywords: Graft failure, Kidney/liver transplantation, Machine preservation, Outcome

Topic: Clinical Science » Liver » 52 - Liver: Kidney Issues in Liver Transplantation

Session Information

Session Name: Liver: Kidney Issues in Liver Transplantation

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Combined liver and kidney transplantation (CLKT) improves the survival in liver transplant recipients with renal dysfunction. However, kidney DGF (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study analyzes the incidence, potential risk factors and prognostic impact of kDGF development following CLKT in a recently transplanted cohort.

*Methods: A uniform population of 115 patients transplanted between January 2015 and February 2021 at a single center in which all transplanted kidneys had received hypothermic pulsatile machine perfusion (HPMP) prior to transplantation was reviewed. The primary outcome was kDGF development. Secondary outcomes included the renal allograft function at 1, 3, 6, and 12 months after transplant, the incidence of kidney primary nonfunction (kPNF), renal allograft futility (RAF), biopsy-proven acute rejection, postoperative hospital-acquired infections and overall morbidity, graft and patient survival and length of hospital stay.

*Results: KDGF was observed in 37,4% (43/115) patients. Multivariable analysis of kDGF revealed the following indipendent predictors: preoperative dialysis, lower recipient BMI, older donor age, utilization of DCD donors and longer delay of kidney transplantation after liver transplantation. With a median follow-up of 36.7 months after transplant, kDGF was associated with a significantly increased risk of developing a post-operative hospital-acquired infection and more severe complications, poorer renal allograft function and worse death-censored graft and patient survival. Higher final HPMP resistive index was significantly associated with an eGFR lower than 45 ml/min/1.73m²at 1 month after transplant.

*Conclusions: KDGF is responsible for remarkable negative effects on immediate and long-term clinical outcomes after CLKT. Understanding the important risk factors for kDGF development in CLKT may help to guide recipient and donor selection and improve clinical decisions in this increasing group of transplant recipients.

Preoperative risk factors contributing to kDGF
^Variable	^P-value	^{Model Coefficient±SE}
^{Recipient BMI}	^0.006	^{-0.142±0.055}
^{Pre-transplant HD}	^0.0003	^2.489±0.766
^{Time from LT to KT}	^0.0003	^0.084±0.025
^{DCD graft}	^0.007	^1.829±0.709
^{Donor age}	^0.003	^0.052±0.019

Predictors of Comprehensive Complication Index (CCI)
^Variable	^P-value	^{Model Coefficient±SE}
^{Pre-transplant HD}	^0.002	^{14.914±4.701}
^{Time from LT to KT}	^0.004	^0.580±0.195
^{PBRCs during LT}	^0.02	^0.314±0.134
^{Postoperative vasopressor support}	^0.006	^{12.249±4.370}
^{Positive Association of kDGF with CCI}	^<0.000001

To cite this abstract in AMA style:

Vincenzi P, Gaynor J, Vianna R, Ciancio G. Predictors of Delayed Kidney Graft Function Following Combined Liver and Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/predictors-of-delayed-kidney-graft-function-following-combined-liver-and-kidney-transplantation/. Accessed May 17, 2025.

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