TY - JOUR
T1 - Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction
T2 - Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival
AU - Tanriover, Bekir
AU - MacConmara, Malcolm P.
AU - Parekh, Justin
AU - Arce, Cristina
AU - Zhang, Song
AU - Gao, Ang
AU - Mufti, Arjmand
AU - Levea, Swee Ling
AU - Sandikci, Burhaneddin
AU - Ayvaci, Mehmet U.S.
AU - Ariyamuthu, Venketash K.
AU - Hwang, Christine
AU - Mohan, Sumit
AU - Mete, Mutlu
AU - Vazquez, Miguel A.
AU - Marrero, Jorge A.
N1 - Publisher Copyright:
© 2016 International Society of Nephrology
PY - 2016
Y1 - 2016
N2 - Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.
AB - Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.
KW - deceased donor quality
KW - dual organ allocation
KW - propensity score matching
KW - simultaneous liver-kidney transplantation
KW - UNOS
UR - http://www.scopus.com/inward/record.url?scp=84995693647&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2016.07.008
DO - 10.1016/j.ekir.2016.07.008
M3 - Article
AN - SCOPUS:84995693647
SN - 2468-0249
VL - 1
SP - 221
EP - 229
JO - Kidney International Reports
JF - Kidney International Reports
IS - 4
ER -