Date: Saturday, June 1, 2019
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall C & D
*Purpose: The development and consequences of renal failure after liver transplantation (LT) are well-chronicled. Kidney after liver transplantation (KALT) is the preferred treatment in this setting. Our aim is to demonstrate the advantages of KALT from a single center’s experience over a 30-year period.
*Methods: With institutional IRB approval, we utilized our prospectively maintained research database to obtain information on all patients receiving a liver transplant at our institution, who later received a kidney transplant at our transplant center or another institution.
*Results: We identified 84 patients (60 male:24 female, median age 56 years) who underwent a LT between 1985 and 2011 at our institution followed by a KALT with a median time 7.6 years (range: 96 days to 18.6 years) between transplants. Ten patients had a liver retransplant and one underwent three LTs prior to KALT. The most common indication was calcineurin inhibitor nephrotoxicity (81%). Sixty-nine patients were on dialysis for a median 1.5 years prior to their kidney transplant. Fifty-five patients underwent a cadaveric KALT and 28 by living donation; 1 unknown. Of the cadaveric recipients, twelve were from donors 50 years of age or older. With a median follow up time of 6.3 years after KALT, the 1, 5 and 10-year patient survival rates were 92%, 67%, and 52%, respectively. There was no difference in kidney graft survival between cadaveric and living donors (p=0.32). Patients receiving kidney allografts from donors less than 50 years of age conferred no better survival than recipients of kidneys from donors 50 years of age or older (p=0.91). Five recipients had their KALT within a year of transplant for acute kidney injury: one died from sepsis within two months and the remaining four survived for a median 8.4 years.
*Conclusions: We demonstrate excellent long-term patient survival for LT recipients undergoing subsequent KALT, whether by live or cadaveric, younger or older donors. This suggests a central role for the use of suitable older renal allografts. Finally, we confirm a relevant function for early KALT in recipients developing acute kidney injury post LT.
To cite this abstract in AMA style:Ruiz R, Holmes K, McKenna G, Onaca N, Testa G, Fernandez H, Bayer J, Wall A, Martinez E, Martinez E, Gupta A, Goldstein R, Klintmalm G. Renal Failure after Liver Transplantation: Benefits from a Little Pinch of KALT [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-failure-after-liver-transplantation-benefits-from-a-little-pinch-of-kalt/. Accessed August 11, 2020.
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