Pita Alejandro, Kaur Navpreet, Emamaullee Juliet, Lo Mary, Nguyen Brian, Sabour Andrew, Tristan Vincent, Nadim Mitra, Genyk Yuri, Sher Linda
Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Department of Preventative Medicine, University of Southern California, Los Angeles, CA.
Transplant Direct. 2019 Sep 19;5(10):e490. doi: 10.1097/TXD.0000000000000935. eCollection 2019 Oct.
As the liver transplant (LT) waiting list continues to outpace organ availability, many patients require renal replacement therapy (RRT) before LT. It is unclear which patients will benefit from simultaneous liver kidney (SLK) transplant as opposed to awaiting a Safety Net kidney transplant (KT) post-LT.
In this study, a retrospective analysis of the United Network for Organ Sharing dataset was performed to identify risk factors associated with poor outcome for patients on RRT before LT who were listed for SLK and received either SLK vs LT alone (LTA).
Between January 2003 and December 2016, 8971 adult LT recipients were on RRT at the time of LT. 5359 were listed for and received LTA (Group 1). Of 3612 patients listed for SLK, 3414 (38.1%) received SLK (Group 2) and 198 (2.2%) received LTA (Group 3). Overall, Group 3 had lower graft and patient survival post-LT when compared with Groups 1 and 2 ( < 0.001). Serum creatinine at 1 year post-LT and cumulative incidence for KT at 3 years post-LT were higher for Group 3 ( < 0.001). On multivariate analysis, pre-LT diabetes ( = 0.002), Model of End-Stage Liver Disease score ( = 0.01), and donor kidney donor profile index ( = 0.025) were significant in Group 2. Recipient age >60 ( < 0.001) and RRT pre-LT (>90 days; = 0.001) were associated with lower patient survival in Group 3.
Among LT recipients on RRT before LT who were listed for SLK, RRT >90 days, and age >60 were associated with poor outcome following LTA. This suggests that programs should carefully weigh the decision to proceed with LTA vs waiting for SLK in this patient population. Future access to Safety Net KT will be an important consideration for these patients moving forward.
由于肝移植（LT）等待名单持续超过器官供应，许多患者在肝移植前需要肾脏替代治疗（RRT）。目前尚不清楚哪些患者接受同期肝肾（SLK）移植会比等待肝移植后接受安全网肾移植（KT）更有益。
在本研究中，对器官共享联合网络数据集进行回顾性分析，以确定在肝移植前接受RRT且被列入SLK名单并接受了SLK或单独肝移植（LTA）的患者预后不良的相关危险因素。
2003年1月至2016年12月期间，8971例成年肝移植受者在肝移植时接受RRT。5359例被列入并接受了LTA（第1组）。在3612例被列入SLK名单的患者中，3414例（38.1%）接受了SLK（第2组），198例（2.2%）接受了LTA（第3组）。总体而言，与第1组和第2组相比，第3组肝移植后的移植物和患者生存率较低（<0.001）。第3组肝移植后1年的血清肌酐和肝移植后3年的KT累积发生率较高（<0.001）。多因素分析显示，肝移植前糖尿病（=0.002）、终末期肝病模型评分（=0.01）和供肾供者特征指数（=0.025）在第2组中具有显著意义。第3组中，受者年龄>60岁（<0.001）和肝移植前RRT（>90天；=0.001）与患者生存率较低相关。
在肝移植前接受RRT且被列入SLK名单的肝移植受者中，RRT>90天和年龄>60岁与接受LTA后的不良预后相关。这表明，对于该患者群体，各项目应仔细权衡进行LTA与等待SLK的决定。未来获得安全网KT将是这些患者未来的一个重要考虑因素。
