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Combined Dual‐Kidney Liver Transplantation in the United States: A Review of United Network for Organ Sharing/Organ Procurement and Transplantation Network Data Between 2002 and 2012
Author(s) -
Shekhtman Grigoriy,
Huang Edmund,
Danovitch Gabriel M.,
Martin Paul,
Bunnapradist Suphamai
Publication year - 2018
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25045
Subject(s) - medicine , kidney , transplantation , united network for organ sharing , kidney transplantation , organ procurement , liver transplantation , organ transplantation , urology , surgery
In kidney‐alone recipients, dual‐kidney transplantation using “higher‐risk” donor organs has shown outcomes comparable to those of single‐kidney transplantation using extended criteria donor (ECD) organs. To investigate the feasibility of a similar approach with combined kidney‐liver transplantation, we identified 22 dual‐kidney liver transplantations (DKLTs) and 3044 single‐kidney liver transplantations (SKLTs) performed in the United States between 2002 and 2012 using United Network for Organ Sharing/Organ Procurement and Transplantation Network registry data. We compared donor/recipient characteristics as well as graft/recipient survival between DKLT recipients and SKLT recipients of “higher‐risk” kidneys (ECD and high kidney donor profile index [KDPI; >85%] donors). Despite having overall similar donor and recipient characteristics compared with both “higher‐risk” donor groups, recipient survival in the DKLT group at 36 months was markedly inferior at 40.9% (compared with 67.5% for ECD SKLT recipients and 64.5% for high‐KDPI SKLT recipients); nondeath‐censored graft survival did not differ. Death was the most common cause of graft loss in all groups. Contrary to dual‐kidney transplantation data in kidney‐alone recipients, DKLT recipients in our study had inferior survival when compared with SKLT recipients of “higher‐risk” donor kidneys. These findings would suggest that dual kidney‐liver transplantation has an uncertain role as a strategy to expand the existing kidney donor pool in combined transplantation.