Vincenzi Paolo, Gaynor Jeffrey J, Vianna Rodrigo, Ciancio Gaetano
Division of Transplant Surgery, Department of Surgery, Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Department of Surgery, Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
J Clin Med. 2022 May 11;11(10):2724. doi: 10.3390/jcm11102724.
Combined liver−kidney transplantation (CLKT) improves patient survival among liver transplant recipients with renal dysfunction. However, kidney delayed graft function (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study analyzed the incidence, potential risk factors, and prognostic impact of kDGF development following CLKT in a recently transplanted cohort. Specifically, 115 consecutive CLKT recipients who were transplanted at our center between January 2015 and February 2021 were studied. All transplanted kidneys received hypothermic pulsatile machine perfusion (HPMP) prior to transplant. The primary outcome was kDGF development. Secondary outcomes included the combined incidence and severity of developing postoperative complications; development of postoperative infections; biopsy-proven acute rejection (BPAR); renal function at 1, 3, 6, and 12 months post-transplant; and death-censored graft and patient survival. kDGF was observed in 37.4% (43/115) of patients. Multivariable analysis of kDGF revealed the following independent predictors: preoperative dialysis (p = 0.0003), lower recipient BMI (p = 0.006), older donor age (p = 0.003), utilization of DCD donors (p = 0.007), and longer delay of kidney transplantation after liver transplantation (p = 0.0003). With a median follow-up of 36.7 months post-transplant, kDGF was associated with a significantly increased risk of developing more severe postoperative complication(s) (p < 0.000001), poorer renal function (particularly at 1 month post-transplant, p < 0.000001), and worse death-censored graft (p = 0.00004) and patient survival (p = 0.0002). kDGF may be responsible for remarkable negative effects on immediate and potentially longer-term clinical outcomes after CLKT. Understanding the important risk factors for kDGF development in CLKT may better guide recipient and donor selection(s) and improve clinical decisions in this increasing group of transplant recipients.
肝肾联合移植（CLKT）可提高肾功能不全的肝移植受者的生存率。然而，肾延迟移植功能（kDGF）仍是一种常见且具有挑战性的并发症，会对临床结局产生负面影响。这项回顾性研究分析了近期接受移植的队列中CLKT后kDGF发生的发生率、潜在风险因素及预后影响。具体而言，对2015年1月至2021年2月期间在本中心接受移植的115例连续CLKT受者进行了研究。所有移植肾在移植前均接受了低温搏动机器灌注（HPMP）。主要结局是kDGF的发生。次要结局包括术后并发症发生的综合发生率和严重程度；术后感染的发生；活检证实的急性排斥反应（BPAR）；移植后1、3、6和12个月时的肾功能；以及死亡截尾的移植物和患者生存率。37.4%（43/115）的患者出现了kDGF。对kDGF的多变量分析显示了以下独立预测因素：术前透析（p = 0.0003）、受者较低的体重指数（p = 0.006）、供者年龄较大（p = 0.003）、脑死亡后器官捐献（DCD）供者的使用（p = 0.007）以及肝移植后肾移植的较长延迟时间（p = 0.0003）。移植后中位随访36.7个月，kDGF与发生更严重术后并发症的风险显著增加相关（p < 0.000,001）、肾功能较差（尤其是移植后1个月时，p < 0.000,001）以及死亡截尾的移植物（p = 0.000,04）和患者生存率较差（p = 0.0002）有关。kDGF可能对CLKT后的近期及可能的长期临床结局产生显著负面影响。了解CLKT中kDGF发生的重要风险因素可能会更好地指导受者和供者的选择，并改善这一不断增加的移植受者群体的临床决策。
