Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Department of Surgery, Hepato-Pancreato-Biliary and Liver Transplantation Surgery Unit, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
Clin Transplant. 2019 Jun;33(6):e13569. doi: 10.1111/ctr.13569. Epub 2019 May 7.
Kidney delayed graft function (kDGF) remains a challenging problem following simultaneous liver and kidney transplantation (SLKT) with a reported incidence up to 40%. Given the scarcity of renal allografts, it is crucial to minimize the development of kDGF among SLKT recipients to improve patient and graft outcomes. We sought to assess the role of preoperative recipient and donor/graft factors on developing kDGF among recipients of SLKT.
A retrospective review of 194 patients who received SLKT in the period from January 2004 to March 2017 in a single center was performed to assess the effect of preoperative factors on the development of kDGF.
Kidney delayed graft function was observed in 95 patients (49%). Multivariate analysis revealed that donor history of hypertension, cold static preservation of kidney grafts [versus using hypothermic pulsatile machine perfusion (HPMP)], donor final creatinine, physiologic MELD, and duration of delay of kidney transplantation after liver transplantation were significant independent predictors for kDGF. kDGF is associated with worse graft function and patient and graft survival.
Kidney delayed graft function has detrimental effects on graft function and graft survival. Understanding the risks and combining careful perioperative patient management, proper recipient selection and donor matching, and graft preservation using HPMP would decrease kDGF among SLKT recipients.
在肝肾联合移植（SLKT）后，肾移植物功能延迟（kDGF）仍然是一个具有挑战性的问题，其发病率高达 40%。由于肾供体的稀缺性，对于 SLKT 受者来说，最大限度地减少 kDGF 的发生对于改善患者和移植物的结局至关重要。我们旨在评估 SLKT 受者术前受者和供者/移植物因素在发展 kDGF 中的作用。
对 2004 年 1 月至 2017 年 3 月在单一中心接受 SLKT 的 194 例患者进行回顾性分析，以评估术前因素对 kDGF 发展的影响。
95 例（49%）患者出现 kDGF。多变量分析显示，供体高血压史、肾脏移植物冷静态保存[与使用低温脉动机器灌注（HPMP）相比]、供体终末期肌酐、生理 MELD 和肝移植后肾脏移植延迟时间是 kDGF 的显著独立预测因素。kDGF 与移植物功能更差、患者和移植物存活率降低有关。
kDGF 对移植物功能和移植物存活率有不良影响。了解风险并结合围手术期患者管理、适当的受者选择和供者匹配以及使用 HPMP 进行移植物保存，可降低 SLKT 受者的 kDGF 发生率。
