Open AccessLiver alone or simultaneous liver–kidney transplant? Pretransplant chronic kidney disease and post‐transplant outcome – a retrospective study
Author(s) -
Nagai Shunji,
Safwan Mohamed,
Collins Kelly,
Schilke Randolph E.,
Rizzari Michael,
Moonka Dilip,
Brown Kimberly,
Patel Anita,
Yoshida Atsushi,
Abouljoud Marwan
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13275
Subject(s) - medicine , hazard ratio , kidney disease , dialysis , odds ratio , renal function , kidney transplantation , gastroenterology , surgery , transplantation , confidence interval
Summary The new Organ Procurement and Transplant Network/United Organ Sharing Network ( OPTN / UNOS ) simultaneous liver–kidney transplant ( SLK ) policy has been implemented. The aim of this study was to review liver transplant outcomes utilizing the new SLK policy. Liver transplant alone ( LTA ) and SLK patients between 2009 and 2015 were reviewed. Graft survival and post‐transplant kidney function were investigated among LTA patients meeting the chronic kidney disease ( CKD ) criteria of the new policy ( LTA ‐ CKD group). To validate our findings, we reviewed and applied our analysis to the OPTN / UNOS registry. A total of 535 patients were eligible from our series. The LTA ‐ CKD group ( n = 27) showed worse 1‐year graft survival, compared with the SLK group ( n = 44), but not significant (81% vs. 93%, P = 0.15). The LTA ‐ CKD group significantly increased a risk of post‐transplant dialysis (odds ratio = 5.59 [95% CI = 1.27–24.7], P = 0.02 [Ref. normal kidney function]). Post‐transplant dialysis was an independent risk factor for graft loss (hazard ratio = 7.25, 95% CI = 3.3–15.91, P < 0.001 [Ref. SLK ]). In the validation analysis based on the OPTN / UNOS registry, the hazard of 1‐year‐graft loss in the LTA ‐ CKD group ( n = 751) was 34.8% higher than the SLK group ( n = 2856) (hazard ratio = 1.348, 95% CI = 1.157–1.572, P < 0.001). Indicating SLK for patients who meet the CKD criteria may significantly improve transplant outcomes.