Barman Pranab M, King Lindsay Y, Berg Carl L, Parish Alice, Niedzwiecki Donna, Barbas Andrew S, McElroy Lisa, Patel Yuval A
Division of Gastroenterology, University of California San Diego, San Diego, CA.
Division of Gastroenterology, Duke University, Durham, NC.
Transplant Direct. 2020 Dec 15;7(1):e640. doi: 10.1097/TXD.0000000000001071. eCollection 2021 Jan.
Midodrine is often needed pretransplant to improve hemodynamics in simultaneous liver-kidney transplant candidates. Previous research has shown that patients requiring midodrine before kidney transplant alone have increased posttransplant risk for delayed allograft function, graft failure, and death. However, the impact of pretransplant midodrine use on outcomes after simultaneous liver-kidney transplant is unknown.
We performed a retrospective study of all adult (age ≥18 y) simultaneous liver-kidney transplant recipients from a single academic transplant center from February 1, 2002, to June 30, 2019.
Sixty-four simultaneous liver-kidney transplants were performed in our institution during this time period, of which, 43 were not on midodrine before transplant, 17 were on midodrine alone, and 4 were on intravenous (IV) vasopressor therapy. Despite the midodrine group having a higher MELD-Na at listing, higher MELD-Na at transplant, and being older, there were no significant differences in key outcomes including delayed renal allograft function, estimated glomerular filtration rate at transplant discharge, and estimated glomerular filtration rate at 1 y after transplant compared with the nonmidodrine group. There was no significant difference in graft failure or survival at last follow-up.
Our study suggests that need for pretransplant midodrine should not be a barrier to simultaneous liver-kidney transplant.
在肝肾联合移植候选者中，移植前常需使用米多君来改善血流动力学。既往研究表明，仅在肾移植前需要米多君的患者移植后发生移植肾功能延迟恢复、移植失败和死亡的风险增加。然而，移植前使用米多君对肝肾联合移植术后结局的影响尚不清楚。
我们对2002年2月1日至2019年6月30日期间来自单一学术移植中心的所有成年（年龄≥18岁）肝肾联合移植受者进行了一项回顾性研究。
在此期间，我们机构共进行了64例肝肾联合移植，其中43例移植前未使用米多君，17例仅使用米多君，4例接受静脉血管加压素治疗。尽管米多君组在登记时的终末期肝病模型钠评分（MELD-Na）较高，移植时的MELD-Na较高，且年龄较大，但与未使用米多君组相比，在包括移植肾功能延迟恢复、移植出院时的估计肾小球滤过率以及移植后1年的估计肾小球滤过率等关键结局方面没有显著差异。在最后一次随访时，移植失败或生存率没有显著差异。
我们的研究表明，移植前需要使用米多君不应成为肝肾联合移植的障碍。
