Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation

Research output: Contribution to journalArticle

Keri E Lunsford, Vatche G Agopian, Stephanie G Yi, Duc T.M. Nguyen, Edward A Graviss, Michael P Harlander-Locke, Ashish Saharia, Fady M Kaldas, Constance M Mobley, Ali Zarrinpar, Mark Hobeika, Jeffery L Veale, Hemangshu Podder, Douglas G Farmer, Richard J Knight, Gabriel M Danovitch, H Albin Gritsch, Xian C Li, R Mark Ghobrial, Ronald W Busuttil & 1 others A Osama Gaber

BACKGROUND: Combined liver-kidney transplantation (CLKT) improves survival for liver transplant recipients with renal dysfunction; however, the tenuous perioperative hemodynamic and metabolic milieu in high acuity CLKT recipients increases delayed graft function and kidney allograft failure. We sought to analyze whether delayed KT through pumping would improve kidney outcomes following CLKT.

METHODS: A retrospective analysis (UCLA [n=145], TMH [n=79]) was performed of all adults receiving CLKT at 2 high-volume transplant centers from February 2004 through January 2017, and recipients were analyzed for patient and allograft survival as well as renal outcomes following CLKT.

RESULTS: 63 patients (28.1%) underwent delayed implantation of pumped kidneys (dCLKT) and 161 patients (71.9%) received early implantation of nonpumped kidneys (eCLKT). Most recipients were high-acuity with median biologic MELD 35 for dCLKT and 34 for eCLKT (p=ns). Pretransplant, dCLKT had longer ICU stay, were more often intubated, and had greater vasopressor use. Despite this, dCLKT exhibited improved 1-, 3-, and 5-yr patient and kidney survival (p=0.02) and decreased length of stay (p=0.001), kidney allograft failure (p=0.012), and dialysis duration (p=0.031). This reduced kidney allograft futility (death or continued need for hemodialysis within 3 months posttransplant) for dCLKT (6.3%) compared with eCLKT (19.9%) (p=0.013).

CONCLUSIONS: Delayed implantation of pumped kidneys is associated with improved patient and renal allograft survival and decreased hospital length of stay despite longer kidney cold ischemia. These data should inform the ethical debate as to the futility of performing CLKT in high-acuity recipients.

Original languageEnglish (US)
JournalTransplantation
DOIs
StateE-pub ahead of print - Oct 23 2019

PMID: 31651787

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Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation. / Lunsford, Keri E; Agopian, Vatche G; Yi, Stephanie G; Nguyen, Duc T.M.; Graviss, Edward A; Harlander-Locke, Michael P; Saharia, Ashish; Kaldas, Fady M; Mobley, Constance M; Zarrinpar, Ali; Hobeika, Mark; Veale, Jeffery L; Podder, Hemangshu; Farmer, Douglas G; Knight, Richard J; Danovitch, Gabriel M; Gritsch, H Albin; Li, Xian C; Ghobrial, R Mark; Busuttil, Ronald W; Gaber, A Osama.

In: Transplantation, 23.10.2019.

Research output: Contribution to journalArticle

Harvard

Lunsford, KE, Agopian, VG, Yi, SG, Nguyen, DTM, Graviss, EA, Harlander-Locke, MP, Saharia, A, Kaldas, FM, Mobley, CM, Zarrinpar, A, Hobeika, M, Veale, JL, Podder, H, Farmer, DG, Knight, RJ, Danovitch, GM, Gritsch, HA, Li, XC, Ghobrial, RM, Busuttil, RW & Gaber, AO 2019, 'Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation' Transplantation. https://doi.org/10.1097/TP.0000000000003040

APA

Lunsford, K. E., Agopian, V. G., Yi, S. G., Nguyen, D. T. M., Graviss, E. A., Harlander-Locke, M. P., ... Gaber, A. O. (2019). Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation. Transplantation. https://doi.org/10.1097/TP.0000000000003040

Vancouver

Lunsford KE, Agopian VG, Yi SG, Nguyen DTM, Graviss EA, Harlander-Locke MP et al. Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation. Transplantation. 2019 Oct 23. https://doi.org/10.1097/TP.0000000000003040

Author

Lunsford, Keri E ; Agopian, Vatche G ; Yi, Stephanie G ; Nguyen, Duc T.M. ; Graviss, Edward A ; Harlander-Locke, Michael P ; Saharia, Ashish ; Kaldas, Fady M ; Mobley, Constance M ; Zarrinpar, Ali ; Hobeika, Mark ; Veale, Jeffery L ; Podder, Hemangshu ; Farmer, Douglas G ; Knight, Richard J ; Danovitch, Gabriel M ; Gritsch, H Albin ; Li, Xian C ; Ghobrial, R Mark ; Busuttil, Ronald W ; Gaber, A Osama. / Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation. In: Transplantation. 2019.

BibTeX

@article{b4c3d5e48b7b4b4a82fbf5204ece6d5e,
title = "Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation",
abstract = "BACKGROUND: Combined liver-kidney transplantation (CLKT) improves survival for liver transplant recipients with renal dysfunction; however, the tenuous perioperative hemodynamic and metabolic milieu in high acuity CLKT recipients increases delayed graft function and kidney allograft failure. We sought to analyze whether delayed KT through pumping would improve kidney outcomes following CLKT.METHODS: A retrospective analysis (UCLA [n=145], TMH [n=79]) was performed of all adults receiving CLKT at 2 high-volume transplant centers from February 2004 through January 2017, and recipients were analyzed for patient and allograft survival as well as renal outcomes following CLKT.RESULTS: 63 patients (28.1{\%}) underwent delayed implantation of pumped kidneys (dCLKT) and 161 patients (71.9{\%}) received early implantation of nonpumped kidneys (eCLKT). Most recipients were high-acuity with median biologic MELD 35 for dCLKT and 34 for eCLKT (p=ns). Pretransplant, dCLKT had longer ICU stay, were more often intubated, and had greater vasopressor use. Despite this, dCLKT exhibited improved 1-, 3-, and 5-yr patient and kidney survival (p=0.02) and decreased length of stay (p=0.001), kidney allograft failure (p=0.012), and dialysis duration (p=0.031). This reduced kidney allograft futility (death or continued need for hemodialysis within 3 months posttransplant) for dCLKT (6.3{\%}) compared with eCLKT (19.9{\%}) (p=0.013).CONCLUSIONS: Delayed implantation of pumped kidneys is associated with improved patient and renal allograft survival and decreased hospital length of stay despite longer kidney cold ischemia. These data should inform the ethical debate as to the futility of performing CLKT in high-acuity recipients.",
author = "Lunsford, {Keri E} and Agopian, {Vatche G} and Yi, {Stephanie G} and Nguyen, {Duc T.M.} and Graviss, {Edward A} and Harlander-Locke, {Michael P} and Ashish Saharia and Kaldas, {Fady M} and Mobley, {Constance M} and Ali Zarrinpar and Mark Hobeika and Veale, {Jeffery L} and Hemangshu Podder and Farmer, {Douglas G} and Knight, {Richard J} and Danovitch, {Gabriel M} and Gritsch, {H Albin} and Li, {Xian C} and Ghobrial, {R Mark} and Busuttil, {Ronald W} and Gaber, {A Osama}",
year = "2019",
month = "10",
day = "23",
doi = "10.1097/TP.0000000000003040",
language = "English (US)",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",

}

RIS

TY - JOUR

T1 - Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver-Kidney Transplantation

AU - Lunsford, Keri E

AU - Agopian, Vatche G

AU - Yi, Stephanie G

AU - Nguyen, Duc T.M.

AU - Graviss, Edward A

AU - Harlander-Locke, Michael P

AU - Saharia, Ashish

AU - Kaldas, Fady M

AU - Mobley, Constance M

AU - Zarrinpar, Ali

AU - Hobeika, Mark

AU - Veale, Jeffery L

AU - Podder, Hemangshu

AU - Farmer, Douglas G

AU - Knight, Richard J

AU - Danovitch, Gabriel M

AU - Gritsch, H Albin

AU - Li, Xian C

AU - Ghobrial, R Mark

AU - Busuttil, Ronald W

AU - Gaber, A Osama

PY - 2019/10/23

Y1 - 2019/10/23

N2 - BACKGROUND: Combined liver-kidney transplantation (CLKT) improves survival for liver transplant recipients with renal dysfunction; however, the tenuous perioperative hemodynamic and metabolic milieu in high acuity CLKT recipients increases delayed graft function and kidney allograft failure. We sought to analyze whether delayed KT through pumping would improve kidney outcomes following CLKT.METHODS: A retrospective analysis (UCLA [n=145], TMH [n=79]) was performed of all adults receiving CLKT at 2 high-volume transplant centers from February 2004 through January 2017, and recipients were analyzed for patient and allograft survival as well as renal outcomes following CLKT.RESULTS: 63 patients (28.1%) underwent delayed implantation of pumped kidneys (dCLKT) and 161 patients (71.9%) received early implantation of nonpumped kidneys (eCLKT). Most recipients were high-acuity with median biologic MELD 35 for dCLKT and 34 for eCLKT (p=ns). Pretransplant, dCLKT had longer ICU stay, were more often intubated, and had greater vasopressor use. Despite this, dCLKT exhibited improved 1-, 3-, and 5-yr patient and kidney survival (p=0.02) and decreased length of stay (p=0.001), kidney allograft failure (p=0.012), and dialysis duration (p=0.031). This reduced kidney allograft futility (death or continued need for hemodialysis within 3 months posttransplant) for dCLKT (6.3%) compared with eCLKT (19.9%) (p=0.013).CONCLUSIONS: Delayed implantation of pumped kidneys is associated with improved patient and renal allograft survival and decreased hospital length of stay despite longer kidney cold ischemia. These data should inform the ethical debate as to the futility of performing CLKT in high-acuity recipients.

AB - BACKGROUND: Combined liver-kidney transplantation (CLKT) improves survival for liver transplant recipients with renal dysfunction; however, the tenuous perioperative hemodynamic and metabolic milieu in high acuity CLKT recipients increases delayed graft function and kidney allograft failure. We sought to analyze whether delayed KT through pumping would improve kidney outcomes following CLKT.METHODS: A retrospective analysis (UCLA [n=145], TMH [n=79]) was performed of all adults receiving CLKT at 2 high-volume transplant centers from February 2004 through January 2017, and recipients were analyzed for patient and allograft survival as well as renal outcomes following CLKT.RESULTS: 63 patients (28.1%) underwent delayed implantation of pumped kidneys (dCLKT) and 161 patients (71.9%) received early implantation of nonpumped kidneys (eCLKT). Most recipients were high-acuity with median biologic MELD 35 for dCLKT and 34 for eCLKT (p=ns). Pretransplant, dCLKT had longer ICU stay, were more often intubated, and had greater vasopressor use. Despite this, dCLKT exhibited improved 1-, 3-, and 5-yr patient and kidney survival (p=0.02) and decreased length of stay (p=0.001), kidney allograft failure (p=0.012), and dialysis duration (p=0.031). This reduced kidney allograft futility (death or continued need for hemodialysis within 3 months posttransplant) for dCLKT (6.3%) compared with eCLKT (19.9%) (p=0.013).CONCLUSIONS: Delayed implantation of pumped kidneys is associated with improved patient and renal allograft survival and decreased hospital length of stay despite longer kidney cold ischemia. These data should inform the ethical debate as to the futility of performing CLKT in high-acuity recipients.

U2 - 10.1097/TP.0000000000003040

DO - 10.1097/TP.0000000000003040

M3 - Article

JO - Transplantation

T2 - Transplantation

JF - Transplantation

SN - 0041-1337

ER -

ID: 54313528