TY - JOUR
T1 - The liver recipient with acute renal dysfunction
T2 - A single institution evaluation of the simultaneous liver-kidney transplant candidate
AU - Yadav, Kunal
AU - Serrano, Oscar K.
AU - Peterson, Kent J.
AU - Pruett, Timothy L.
AU - Kandaswamy, Raja
AU - Bangdiwala, Ananta
AU - Ibrahim, Hassan
AU - Israni, Ajay
AU - Lake, John
AU - Chinnakotla, Srinath
PY - 2018/1
Y1 - 2018/1
N2 - The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver-kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short-term preoperative kidney dysfunction (creatinine >4 mg/dL or preoperative hemodialysis [HD] for <6 weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end-stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P <.0001) and higher incidence of pre-LT diabetes in the SLK cohort (52% vs 26.5%, P =.0176). Duration of pre-LT HD was higher in SLK recipients, but the difference was not statistically significant (P =.39). Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1-year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short-term (<6 weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients.
AB - The Organ Procurement Transplant Network (OPTN) listing criteria for simultaneous liver-kidney transplant (SLK) are not well defined. Concerns remain about rising numbers of SLKs, which divert quality kidneys from candidates awaiting kidney transplants (KT). We performed a retrospective review of liver transplants (LTs) at our center from 2004 to 2014; 127 recipients (liver transplant alone; 102 LTA, 25 SLK) were identified with short-term preoperative kidney dysfunction (creatinine >4 mg/dL or preoperative hemodialysis [HD] for <6 weeks). Both cohorts had comparable baseline demographic characteristics with the exception of higher model for end-stage liver disease (MELD) score in the LTA group (41.4 vs 32.9, P <.0001) and higher incidence of pre-LT diabetes in the SLK cohort (52% vs 26.5%, P =.0176). Duration of pre-LT HD was higher in SLK recipients, but the difference was not statistically significant (P =.39). Renal nonrecovery (RNR) rate in LTA cohort was low (<5%). No significant difference was noted in 1-year mortality, liver graft rejection/failure, or length of stay (LOS) between the cohorts. Thus, it appears that liver recipients with short-term (<6 weeks) HD or AKI without HD have comparable outcomes between LTA and SLK. With provisions for a KT safety net, as proposed by OPTN, LTA may be the most adequate option for these patients.
KW - acute kidney injury
KW - kidney transplant
KW - liver transplant
KW - organ procurement and transplantation network (OPTN)
KW - simultaneous liver-kidney transplant
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U2 - 10.1111/ctr.13148
DO - 10.1111/ctr.13148
M3 - Article
C2 - 29105843
AN - SCOPUS:85035009028
VL - 32
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 1
M1 - e13148
ER -