Kumar Shiva, Pedersen Rachel, Sahajpal Ajay
From the Department of Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
From the Transplant Center, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA.
Exp Clin Transplant. 2023 Apr;21(4):299-306. doi: 10.6002/ect.2023.0035.
Limited data exist on outcomes after simultaneous liver-kidney transplants with extended criteria donor grafts. We compared outcomes in recipients of simultaneous liver-kidney transplants with donation after circulatory death versus donation after brain death grafts.
This retrospective analysis included all liver transplants performed over a 7-year period at a single center. We compared categorical variables using the chi-square test and continuous variables using the t test. We compared survival using the Kaplan-Meier method and performed a univariate analysis of predictors of outcomes using Cox regression method.
Over the study period, 196 patients underwent liver transplant, with 33 (16.8%) undergoing simultaneous liver-kidney transplant. In this cohort, 23 and 10 patients, respectively, received grafts from donors after brain death versus circulatory death. Both groups were comparable with respect to age, sex, hepatitis C virus status, and presence of hepatocellular carcinoma. Median (range) Model for End-Stage Liver Disease score was higher in recipients of donation after brain death grafts (37 [26-40] vs 23 [21-24]; P < .01). Liver allograft survival was comparable in donation after brain death versus donation after circulatory death recipients (P = .82) at 1 year (64.0% vs 66.7%), 3 years (57.6% vs 55.6%), and 5 years (57.6% vs 55.6%). Patient survival was also comparable (P = .89) at 1 year (70.1% vs 77.8%), 3 years (63.1% vs 55.6%), and 5 years (63.1% vs 55.6%). Graft outcomes remained similar even after adjustment for Model for End-Stage Liver Disease score at transplant (hazard ratio 0.58; 95% CI, 0.14-2.44; P = .45). Univariate analysis of predictors of patient survival after simultaneous liver- kidney transplant showed a trend toward statistical significance with recipient age and donor male sex.
Grafts from donors after circulatory death could help safely expand the donor pool in patients undergoing simultaneous liver-kidney transplant without compromising outcomes.
关于使用扩大标准供体移植物进行肝肾联合移植后的预后数据有限。我们比较了接受脑死亡后捐赠与循环死亡后捐赠的肝肾联合移植受者的预后情况。
这项回顾性分析纳入了在单一中心7年期间进行的所有肝移植手术。我们使用卡方检验比较分类变量，使用t检验比较连续变量。我们使用Kaplan-Meier方法比较生存率，并使用Cox回归方法对预后预测因素进行单因素分析。
在研究期间，196例患者接受了肝移植，其中33例（16.8%）接受了肝肾联合移植。在这个队列中，分别有23例和10例患者接受了脑死亡后捐赠与循环死亡后捐赠的移植物。两组在年龄、性别、丙型肝炎病毒状态和肝细胞癌存在情况方面具有可比性。脑死亡后捐赠移植物的受者终末期肝病模型评分中位数（范围）更高（37 [26 - 40] 对比 23 [21 - 24]；P <.01）。脑死亡后捐赠与循环死亡后捐赠的受者在1年（64.0% 对比 66.7%）、3年（57.6% 对比 55.6%）和5年（57.6% 对比 55.6%）时肝移植存活率具有可比性（P =.82）。患者生存率在1年（70.1% 对比 77.8%）、3年（63.1% 对比 55.6%）和5年（63.1% 对比 55.6%）时也具有可比性（P =.89）。即使在对移植时的终末期肝病模型评分进行调整后，移植物预后仍然相似（风险比0.58；95%置信区间，0.14 - 2.44；P =.45）。对肝肾联合移植后患者生存预测因素的单因素分析显示，受者年龄和供体男性性别有统计学意义的趋势。
循环死亡后捐赠者的移植物有助于安全扩大肝肾联合移植患者的供体库，且不影响预后。
