A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes
The aim of this study was to compare the outcomes of simultaneous and delayed implantation of kidney grafts in combined liver-kidney transplantation (CLKT). Delayed function of the renal graft (DGF), which can result from hypotension and pressor use related to the liver transplantation (LT), may cau...
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| Veröffentlicht in: | Annals of surgery 2017-05, Vol.265 (5), p.1000-1008 |
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| creator | Ekser, Burcin Mangus, Richard S Fridell, W Kubal, Chandrashekhar A Nagai, Shunji Kinsella, Sandra B Bayt, Demetria R Bell, Teresa M Powelson, John A Goggins, William C Tector, A Joseph |
| description | The aim of this study was to compare the outcomes of simultaneous and delayed implantation of kidney grafts in combined liver-kidney transplantation (CLKT).
Delayed function of the renal graft (DGF), which can result from hypotension and pressor use related to the liver transplantation (LT), may cause worse outcomes in CLKT.
A total of 130 CLKTs were performed at Indiana University between 2002 and 2015 and studied in an observational cohort study. All kidneys underwent continuous hypothermic pulsatile machine perfusion until transplant: 69 with simultaneous kidney transplantation (KT) (at time of LT, group 1) and 61 with delayed KT (performed at a later time as a second operation, group 2). All patients received continuous veno-venous hemodialysis during the LT. Propensity score match analysis in a 1:1 case-match was performed.
Mean kidney cold ischemia time was 10 ± 3 and 50 ± 15 hours, for groups 1 and 2 (P < 0.0001), respectively. The rate of DGF was 7.3% in group 1, but no DGF was seen in group 2 (P = 0.0600). Kidney function was significantly better in group 2, if the implantation of kidneys was delayed >48 hours (P < 0.01). Patient survival was greater in group 2 at 1 year (91%), and 5 year (87%) post-transplantation (P = 0.0019). On multivariate analysis, DGF [hazard ratio (HR), 165.7; 95% confidence interval (CI), 9.4-2926], extended criteria donor kidneys (HR, 15.9; 95% CI 1.8-145.2), and recipient hepatitis C (HR, 5.5; 95% CI 1.7-17.8) were significant independent risk factors for patient survival.
Delayed KT in CLKT (especially if delayed >48 h) is associated with improved kidney function with no DGF post-KT, and improved patient and graft survival. |
| doi_str_mv | 10.1097/SLA.0000000000001752 |
| format | Article |
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Delayed function of the renal graft (DGF), which can result from hypotension and pressor use related to the liver transplantation (LT), may cause worse outcomes in CLKT.
A total of 130 CLKTs were performed at Indiana University between 2002 and 2015 and studied in an observational cohort study. All kidneys underwent continuous hypothermic pulsatile machine perfusion until transplant: 69 with simultaneous kidney transplantation (KT) (at time of LT, group 1) and 61 with delayed KT (performed at a later time as a second operation, group 2). All patients received continuous veno-venous hemodialysis during the LT. Propensity score match analysis in a 1:1 case-match was performed.
Mean kidney cold ischemia time was 10 ± 3 and 50 ± 15 hours, for groups 1 and 2 (P < 0.0001), respectively. The rate of DGF was 7.3% in group 1, but no DGF was seen in group 2 (P = 0.0600). Kidney function was significantly better in group 2, if the implantation of kidneys was delayed >48 hours (P < 0.01). Patient survival was greater in group 2 at 1 year (91%), and 5 year (87%) post-transplantation (P = 0.0019). On multivariate analysis, DGF [hazard ratio (HR), 165.7; 95% confidence interval (CI), 9.4-2926], extended criteria donor kidneys (HR, 15.9; 95% CI 1.8-145.2), and recipient hepatitis C (HR, 5.5; 95% CI 1.7-17.8) were significant independent risk factors for patient survival.
Delayed KT in CLKT (especially if delayed >48 h) is associated with improved kidney function with no DGF post-KT, and improved patient and graft survival.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000001752</identifier><identifier>PMID: 28398965</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Cohort Studies ; Combined Modality Therapy ; Databases, Factual ; Graft Rejection ; Graft Survival ; Humans ; Kaplan-Meier Estimate ; Kidney Function Tests ; Kidney Transplantation - adverse effects ; Kidney Transplantation - methods ; Kidney Transplantation - mortality ; Liver Function Tests ; Liver Transplantation - adverse effects ; Liver Transplantation - methods ; Liver Transplantation - mortality ; Middle Aged ; Multivariate Analysis ; Postoperative Care - methods ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Recovery of Function ; Retrospective Studies ; Survival Rate ; Transplantation Immunology ; Treatment Outcome</subject><ispartof>Annals of surgery, 2017-05, Vol.265 (5), p.1000-1008</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-232480239d7caa8c193594bb9d898b69d4a3d98eb6d7cfd475057b227371ea913</citedby><cites>FETCH-LOGICAL-c358t-232480239d7caa8c193594bb9d898b69d4a3d98eb6d7cfd475057b227371ea913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28398965$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ekser, Burcin</creatorcontrib><creatorcontrib>Mangus, Richard S</creatorcontrib><creatorcontrib>Fridell, W</creatorcontrib><creatorcontrib>Kubal, Chandrashekhar A</creatorcontrib><creatorcontrib>Nagai, Shunji</creatorcontrib><creatorcontrib>Kinsella, Sandra B</creatorcontrib><creatorcontrib>Bayt, Demetria R</creatorcontrib><creatorcontrib>Bell, Teresa M</creatorcontrib><creatorcontrib>Powelson, John A</creatorcontrib><creatorcontrib>Goggins, William C</creatorcontrib><creatorcontrib>Tector, A Joseph</creatorcontrib><title>A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>The aim of this study was to compare the outcomes of simultaneous and delayed implantation of kidney grafts in combined liver-kidney transplantation (CLKT).
Delayed function of the renal graft (DGF), which can result from hypotension and pressor use related to the liver transplantation (LT), may cause worse outcomes in CLKT.
A total of 130 CLKTs were performed at Indiana University between 2002 and 2015 and studied in an observational cohort study. All kidneys underwent continuous hypothermic pulsatile machine perfusion until transplant: 69 with simultaneous kidney transplantation (KT) (at time of LT, group 1) and 61 with delayed KT (performed at a later time as a second operation, group 2). All patients received continuous veno-venous hemodialysis during the LT. Propensity score match analysis in a 1:1 case-match was performed.
Mean kidney cold ischemia time was 10 ± 3 and 50 ± 15 hours, for groups 1 and 2 (P < 0.0001), respectively. The rate of DGF was 7.3% in group 1, but no DGF was seen in group 2 (P = 0.0600). Kidney function was significantly better in group 2, if the implantation of kidneys was delayed >48 hours (P < 0.01). Patient survival was greater in group 2 at 1 year (91%), and 5 year (87%) post-transplantation (P = 0.0019). On multivariate analysis, DGF [hazard ratio (HR), 165.7; 95% confidence interval (CI), 9.4-2926], extended criteria donor kidneys (HR, 15.9; 95% CI 1.8-145.2), and recipient hepatitis C (HR, 5.5; 95% CI 1.7-17.8) were significant independent risk factors for patient survival.
Delayed KT in CLKT (especially if delayed >48 h) is associated with improved kidney function with no DGF post-KT, and improved patient and graft survival.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Databases, Factual</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Function Tests</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Kidney Transplantation - methods</subject><subject>Kidney Transplantation - mortality</subject><subject>Liver Function Tests</subject><subject>Liver Transplantation - adverse effects</subject><subject>Liver Transplantation - methods</subject><subject>Liver Transplantation - mortality</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Postoperative Care - methods</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Recovery of Function</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Transplantation Immunology</subject><subject>Treatment Outcome</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkF1LwzAUhoMobk7_gUguvenMR9skl2X4hcVduOFlSZvMRdqkJu1g_97IVMRzc-DwnHNeHgAuMZpjJNjNS1nM0Z_CLCNHYIozwhOMU3QMpnFKk1RQMgFnIbxHJuWInYIJ4VRwkWdTsC7gs9vpFhZ9751sttBYuHBdbaxWsDQ77aG0Cj4ZZfUerry0oW-lHeRgnIWvZtjC0tm3ZNC-g8txaFynwzk42cg26IvvPgPru9vV4iEpl_ePi6JMGprxISGUxECECsUaKXmDBc1EWtdCccHrXKhUUiW4rvMIbFTKMpSxmhBGGdZSYDoD14e7MfvHqMNQdSY0uo0BtRtDhTlnKMM5YxFND2jjXQheb6rem076fYVR9SW0ikKr_0Lj2tX3h7HutPpd-jFIPwGT12-o</recordid><startdate>201705</startdate><enddate>201705</enddate><creator>Ekser, Burcin</creator><creator>Mangus, Richard S</creator><creator>Fridell, W</creator><creator>Kubal, Chandrashekhar A</creator><creator>Nagai, Shunji</creator><creator>Kinsella, Sandra B</creator><creator>Bayt, Demetria R</creator><creator>Bell, Teresa M</creator><creator>Powelson, John A</creator><creator>Goggins, William C</creator><creator>Tector, A Joseph</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201705</creationdate><title>A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes</title><author>Ekser, Burcin ; Mangus, Richard S ; Fridell, W ; Kubal, Chandrashekhar A ; Nagai, Shunji ; Kinsella, Sandra B ; Bayt, Demetria R ; Bell, Teresa M ; Powelson, John A ; Goggins, William C ; Tector, A Joseph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-232480239d7caa8c193594bb9d898b69d4a3d98eb6d7cfd475057b227371ea913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Databases, Factual</topic><topic>Graft Rejection</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Function Tests</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Kidney Transplantation - methods</topic><topic>Kidney Transplantation - mortality</topic><topic>Liver Function Tests</topic><topic>Liver Transplantation - adverse effects</topic><topic>Liver Transplantation - methods</topic><topic>Liver Transplantation - mortality</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Postoperative Care - methods</topic><topic>Prognosis</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Recovery of Function</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Transplantation Immunology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ekser, Burcin</creatorcontrib><creatorcontrib>Mangus, Richard S</creatorcontrib><creatorcontrib>Fridell, W</creatorcontrib><creatorcontrib>Kubal, Chandrashekhar A</creatorcontrib><creatorcontrib>Nagai, Shunji</creatorcontrib><creatorcontrib>Kinsella, Sandra B</creatorcontrib><creatorcontrib>Bayt, Demetria R</creatorcontrib><creatorcontrib>Bell, Teresa M</creatorcontrib><creatorcontrib>Powelson, John A</creatorcontrib><creatorcontrib>Goggins, William C</creatorcontrib><creatorcontrib>Tector, A Joseph</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ekser, Burcin</au><au>Mangus, Richard S</au><au>Fridell, W</au><au>Kubal, Chandrashekhar A</au><au>Nagai, Shunji</au><au>Kinsella, Sandra B</au><au>Bayt, Demetria R</au><au>Bell, Teresa M</au><au>Powelson, John A</au><au>Goggins, William C</au><au>Tector, A Joseph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2017-05</date><risdate>2017</risdate><volume>265</volume><issue>5</issue><spage>1000</spage><epage>1008</epage><pages>1000-1008</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>The aim of this study was to compare the outcomes of simultaneous and delayed implantation of kidney grafts in combined liver-kidney transplantation (CLKT).
Delayed function of the renal graft (DGF), which can result from hypotension and pressor use related to the liver transplantation (LT), may cause worse outcomes in CLKT.
A total of 130 CLKTs were performed at Indiana University between 2002 and 2015 and studied in an observational cohort study. All kidneys underwent continuous hypothermic pulsatile machine perfusion until transplant: 69 with simultaneous kidney transplantation (KT) (at time of LT, group 1) and 61 with delayed KT (performed at a later time as a second operation, group 2). All patients received continuous veno-venous hemodialysis during the LT. Propensity score match analysis in a 1:1 case-match was performed.
Mean kidney cold ischemia time was 10 ± 3 and 50 ± 15 hours, for groups 1 and 2 (P < 0.0001), respectively. The rate of DGF was 7.3% in group 1, but no DGF was seen in group 2 (P = 0.0600). Kidney function was significantly better in group 2, if the implantation of kidneys was delayed >48 hours (P < 0.01). Patient survival was greater in group 2 at 1 year (91%), and 5 year (87%) post-transplantation (P = 0.0019). On multivariate analysis, DGF [hazard ratio (HR), 165.7; 95% confidence interval (CI), 9.4-2926], extended criteria donor kidneys (HR, 15.9; 95% CI 1.8-145.2), and recipient hepatitis C (HR, 5.5; 95% CI 1.7-17.8) were significant independent risk factors for patient survival.
Delayed KT in CLKT (especially if delayed >48 h) is associated with improved kidney function with no DGF post-KT, and improved patient and graft survival.</abstract><cop>United States</cop><pmid>28398965</pmid><doi>10.1097/SLA.0000000000001752</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Cohort Studies Combined Modality Therapy Databases, Factual Graft Rejection Graft Survival Humans Kaplan-Meier Estimate Kidney Function Tests Kidney Transplantation - adverse effects Kidney Transplantation - methods Kidney Transplantation - mortality Liver Function Tests Liver Transplantation - adverse effects Liver Transplantation - methods Liver Transplantation - mortality Middle Aged Multivariate Analysis Postoperative Care - methods Prognosis Propensity Score Proportional Hazards Models Recovery of Function Retrospective Studies Survival Rate Transplantation Immunology Treatment Outcome |
| title | A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes |
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