Schold Jesse D, Mohan Sumit, Jackson Whitney E, Stites Erik, Burton James R, Bababekov Yanik J, Saben Jessica L, Pomposelli James J, Pomfret Elizabeth A, Kaplan Bruce
Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Clin J Am Soc Nephrol. 2024 Mar 1;19(3):364-373. doi: 10.2215/CJN.0000000000000353. Epub 2023 Nov 14.
The number of simultaneous liver-kidney (SLK) transplants has significantly increased in the United States. There has also been an increase in kidney-after-liver transplants associated with 2017 policy revisions aimed to fairly allocate kidneys after livers. SLK and kidney-after-liver candidates are prioritized in allocation policy for kidney offers ahead of kidney-alone candidates.
We compared kidney graft outcomes of kidney-alone transplant recipients with SLK and kidney-after-liver transplants using paired kidney models to mitigate differences among donor risk factors. We evaluated recipient characteristics between transplant types and calculated differential graft years using restricted mean survival estimates.
We evaluated 3053 paired donors to kidney-alone and SLK recipients and 516 paired donors to kidney-alone and kidney-after-liver recipients from August 2017 to August 2022. Kidney-alone recipients were younger, more likely on dialysis, and Black race. One-year and 3-year post-transplant kidney graft survival for kidney-alone recipients was 94% and 86% versus SLK recipients 89% and 80%, respectively, P < 0.001. One-year and 3-year kidney graft survival for kidney-alone recipients was 94% and 84% versus kidney-after-liver recipients 93% and 87%, respectively, P = 0.53. The additional kidney graft years for kidney-alone versus SLK transplants was 21 graft years/100 transplants (SEM=5.0) within 4 years post-transplantation, with no significant difference between kidney-after-liver and kidney-alone transplants.
Over a 5-year period in the United States, SLK transplantation was associated with significantly lower kidney graft survival compared with paired kidney-alone transplants. Most differences in graft survival between SLK and kidney-alone transplants occurred within the first year post-transplantation. By contrast, kidney-after-liver transplants had comparable graft survival with paired kidney-alone transplants.
在美国，肝肾联合移植（SLK）的数量显著增加。与2017年旨在公平分配肝后肾脏的政策修订相关的肝后肾移植数量也有所增加。在肾脏分配政策中，SLK和肝后肾候选者在肾脏供体分配上优先于单纯肾移植候选者。
我们使用配对肾脏模型比较了单纯肾移植受者与SLK及肝后肾移植受者的肾移植结局，以减轻供体风险因素之间的差异。我们评估了不同移植类型之间的受者特征，并使用受限平均生存估计值计算差异移植年数。
我们评估了2017年8月至2022年8月间3053例配对给单纯肾移植受者和SLK受者的供体，以及516例配对给单纯肾移植受者和肝后肾移植受者的供体。单纯肾移植受者更年轻，更有可能接受透析治疗，且多为黑人。单纯肾移植受者移植后1年和3年的肾移植存活率分别为94%和86%，而SLK受者分别为89%和80%，P<0.001。单纯肾移植受者移植后1年和3年的肾移植存活率分别为94%和84%，而肝后肾移植受者分别为93%和87%，P = 0.53。单纯肾移植与SLK移植相比，移植后4年内额外的肾移植年数为21移植年/100例移植（标准误=5.0），肝后肾移植与单纯肾移植之间无显著差异。
在美国的5年期间，与配对的单纯肾移植相比，SLK移植的肾移植存活率显著降低。SLK与单纯肾移植之间移植存活率的大多数差异发生在移植后的第一年内。相比之下，肝后肾移植与配对的单纯肾移植具有相当的移植存活率。
