Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Francisco, CA.
Center for Liver Disease and Transplantation, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY.
Transplantation. 2021 Apr 1;105(4):816-823. doi: 10.1097/TP.0000000000003310.
With the implementation of the "Safety Net," we aimed to determine the impact of simultaneous liver-kidney transplantation (SLKT), as compared to kidney transplant after liver transplant (KALT), on kidney allograft failure (KF).
An analysis of the UNOS database for all adult patients who received either an SLKT or KALT from 2002 to 2017. The outcomes were 90-day KF and 1-year KF (as reported to UNOS, at 90- and 365-day postkidney transplant, respectively). We compared the following groups of patients: SLKT <25 (SLKT with final model for end-stage liver disease [MELD] <25), SLKT25/35 (MELD ≥25/<35), and SLKT35 (MELD ≥35) to KALT.
Of the 6276 patients, there were 1481 KALT, 1579 SLKT <25, 1832 SLKT25/35, and 1384 SLKT ≥35. The proportion of patients with 90-day and 1-year KF increased significantly among the KALT, SLKT <25, SLKT25/35, and SLKT ≥35 groups (P < 0.001; test for trend): 90-day KF: 3.3% versus 5.5% versus 7.3% versus 9.3% and 1-year KF: 5.1% versus 9.4% versus 12.3% versus 14.7%. After adjustment and compared with KALT, beginning at an MELD ≥25 those undergoing SLKT had significantly higher risk of 90-day and 1-year KF: 90-day KF: SLKT25/35: hazard ratio, 1.6(1.0-2.3); SLKT ≥35: 2.1(1.3-3.3); 1-year KF: SLKT25/35: hazard ratio, 1.7(1.2-2.4); SLKT ≥35: 2.1(1.5-3.0).
As compared to KALT recipients, SLKT recipients with an MELD ≥25 had significantly higher risk of early KF. Given the now well-established "Safety Net," KALT may serve as an opportunity to improve kidney outcomes in patients with an MELD ≥25.
随着“安全网”的实施，我们旨在确定同期肝肾联合移植（SLKT）与肝肾联合移植后肾移植（KALT）相比，对肾移植失败（KF）的影响。
对 2002 年至 2017 年期间接受 SLKT 或 KALT 的所有成人患者的 UNOS 数据库进行分析。结果为 90 天 KF 和 1 年 KF（UNOS 报告，分别在肾移植后 90 天和 365 天）。我们比较了以下几组患者：SLKT<25（终末期肝病模型 [MELD] 终末期<25 的 SLKT）、SLKT25/35（MELD≥25/<35）和 SLKT35（MELD≥35）与 KALT。
在 6276 例患者中，有 1481 例 KALT、1579 例 SLKT<25、1832 例 SLKT25/35 和 1384 例 SLKT≥35。随着 KALT、SLKT<25、SLKT25/35 和 SLKT≥35 组的 90 天和 1 年 KF 比例显著增加（P<0.001；趋势检验）：90 天 KF：3.3%对 5.5%对 7.3%对 9.3%和 1 年 KF：5.1%对 9.4%对 12.3%对 14.7%。经过调整并与 KALT 相比，MELD≥25 的患者开始接受 SLKT，其 90 天和 1 年 KF 的风险显著增加：90 天 KF：SLKT25/35：风险比，1.6（1.0-2.3）；SLKT≥35：2.1（1.3-3.3）；1 年 KF：SLKT25/35：风险比，1.7（1.2-2.4）；SLKT≥35：2.1（1.5-3.0）。
与 KALT 受者相比，MELD≥25 的 SLKT 受者早期发生 KF 的风险显著增加。鉴于现在已经建立的“安全网”，KALT 可能为 MELD≥25 的患者改善肾脏结局提供机会。
