Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Room 309
*Purpose: Allosensitization is thought to have marginal impact among patients that undergo liver transplantation (LTA); further among simultaneous liver kidney transplantation (SLKT), livers may protect organs transplanted simultaneously from the same donor. We hypothesized that allosensitization has significant clinical and economic impact on transplant outcomes healthcare systems.
*Methods: We examined all LTA and SLKT transplanted in the US (1995-2016). Patients were stratified by presence of allosensitization (positive T cell cross match &/or Panel Reactive Antibodies > 20%). Patients missing XM or PRA data were excluded from the study.
*Results: 17,371 LTA and 1943 SLK patients were transplanted in the study period and met the inclusion criteria. Compared to non-sensitized LA recipients, allosensitized counterparts had longer median initial hospital stay 13 (IQR 8-25) vs. 11 (IQR 8-19), p <0.001. Similarly, allosensitized SLK had longer median initial hospital stay 21 (IQR 11-42) vs. 15 (IQR 9-33), p <0.001. Allosensitized LA and SLK recipients also had higher rate of readmission in the 1st6 months after LTA (14% vs. 10%, p < 0.001) and SLKT (12 vs. 9%, p <0.001, respectively). Rates of rejection at discharge were higher for allosensitized recipients after LTA (6.7 % vs. 5.8%, p=0.03) as well as SLKT (3.9% vs. 1.8%, p=0.01). Rates of liver graft failure were higher for sensitized patients both after LTA and SLKT. (Figure 1a and b). Further, rates of kidney graft failure were higher for sensitized patients after SLKT (Figure 1c). After adjusting for donor, recipient and transplant related characteristics, allosensitization was associated with increased mortality after LTA (AHR=1.06, 95% C.I. 1.00-1.12) as well as SLKT (AHR=1.07, 95% C.I. 1.01-1.13).
*Conclusions: This analysis shows that LTA and SLKT in allosensitized recipients is associated with significantly longer hospital stay and readmissions with a modest albeit statically significant higher rates of rejection, graft loss and patient death. This economic impact of allosensitization maybe applicable to other organ transplants and warrants further investigation.
To cite this abstract in AMA style:Askar M, Saracino G, Elsabbagh A, Fung J, Srinivas T, Flechner S, Trotter J, Testa G, Kaplan B, Klintmalm G, Schold J, Asrani S. The Clinical & Economic Impact Of Allosensitization In Liver Alone And Simultaneous Liver Kidney Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/the-clinical-economic-impact-of-allosensitization-in-liver-alone-and-simultaneous-liver-kidney-transplantation/. Accessed October 27, 2020.
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