Division of Gastroenterology and Hepatology Michigan Medicine Ann Arbor MI Department of Biostatistics, School of Public Health Michigan Medicine Ann Arbor MI Department of Surgery Michigan Medicine Ann Arbor MI Division of Gastroenterology and Hepatology University of California San Diego CA Division of Gastroenterology Duke University Durham NC Section of Internal Medicine Westchester Medical Center Westchester NY Division of Digestive Diseases University of California Los Angeles CA Division of Gastroenterology and Hepatology University of Washington Seattle WA Center for Liver Disease and Transplantation Columbia University Irving Medical Center New York NY Division of Gastroenterology and Hepatology University of California San Francisco CA Division of Gastroenterology and Hepatology Northwestern University Chicago IL.
Liver Transpl. 2021 Aug;27(8):1144-1153. doi: 10.1002/lt.26032. Epub 2021 Apr 21.
Simultaneous liver-kidney transplantation (SLKT) is increasingly common in the United States. However, little is known about the renal-related outcomes following SLKT, which are essential to maximize the health of these allografts. We examined the factors impacting renal function following SLKT. This is an observational multicenter cohort study from the US Multicenter SLKT Consortium consisting of recipients of SLKT aged ≥18 years of transplantations performed between February 2002 and June 2017 at 6 large US centers in 6 different United Network for Organ Sharing regions. The primary outcome was incident post-SLKT stage 4-5 chronic kidney disease (CKD) defined as <30 mL/minute/1.73 m or listing for kidney transplant. The median age of the recipients (n = 570) was 58 years (interquartile range, 51-64 years), and 37% were women, 76% were White, 33% had hepatitis C virus infection, 20% had nonalcoholic steatohepatitis (NASH), and 23% had alcohol-related liver disease; 68% developed ≥ stage 3 CKD at the end of follow-up. The 1-year, 3-year, and 5-year incidence rates of post-SLKT stage 4-5 CKD were 10%, 12%, and 16%, respectively. Pre-SLKT diabetes mellitus (hazard ratio [HR], 1.45; 95% CI, 1.00-2.15), NASH (HR, 1.58; 95% CI, 1.01-2.45), and delayed kidney graft function (HR, 1.72; 95% CI, 1.10-2.71) were the recipient factors independently associated with high risk, whereas the use of tacrolimus (HR, 0.44; 95% CI, 0.22-0.89) reduced the risk. Women (β = -6.22 ± 2.16 mL/minute/1.73 m ; P = 0.004), NASH (β = -7.27 ± 3.27 mL/minute/1.73 m ; P = 0.027), and delayed kidney graft function (β = -7.25 ± 2.26 mL/minute/1.73 m ; P = 0.007) were independently associated with low estimated glomerular filtration rate at last follow-up. Stage 4-5 CKD is common after SLKT. There remains an unmet need for personalized renal protective strategies, specifically stratified by sex, diabetes mellitus, and liver disease, to preserve renal function among SLKT recipients.
肝肾联合移植（SLKT）在美国越来越普遍。然而，对于 SLKT 后与肾脏相关的结果知之甚少，这些结果对于最大限度地提高这些同种异体移植物的健康至关重要。我们研究了影响 SLKT 后肾功能的因素。这是一项来自美国多中心 SLKT 联盟的观察性多中心队列研究，该联盟由在 6 个不同的美国器官共享联合网络区域的 6 个大型美国中心进行的 2002 年 2 月至 2017 年 6 月期间年龄≥18 岁的 SLKT 受者组成。主要结局是新发 SLKT 后 4-5 期慢性肾脏病（CKD），定义为<30 mL/min/1.73 m 或需要进行肾脏移植。受者（n=570）的中位年龄为 58 岁（四分位距，51-64 岁），37%为女性，76%为白人，33%患有丙型肝炎病毒感染，20%患有非酒精性脂肪性肝炎（NASH），23%患有酒精相关性肝病；68%的患者在随访结束时发展为≥3 期 CKD。SLKT 后 4-5 期 CKD 的 1 年、3 年和 5 年发生率分别为 10%、12%和 16%。术前糖尿病（危险比[HR]，1.45；95%CI，1.00-2.15）、NASH（HR，1.58；95%CI，1.01-2.45）和延迟的肾脏移植物功能（HR，1.72；95%CI，1.10-2.71）是与高风险相关的受者因素，而使用他克莫司（HR，0.44；95%CI，0.22-0.89）降低了风险。女性（β=-6.22±2.16 mL/min/1.73 m；P=0.004）、NASH（β=-7.27±3.27 mL/min/1.73 m；P=0.027）和延迟的肾脏移植物功能（β=-7.25±2.26 mL/min/1.73 m；P=0.007）与最后一次随访时的估算肾小球滤过率低独立相关。SLKT 后 CKD 很常见。在 SLKT 受者中，仍需要针对性别、糖尿病和肝脏疾病进行个体化的肾脏保护策略，以维持肾脏功能。
