Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA.
Department of Medicine, Division of Kidney Diseases and Hypertension, Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA.
Liver Transpl. 2024 Jun 1;30(6):582-594. doi: 10.1097/LVT.0000000000000302. Epub 2023 Nov 29.
The number of kidney after liver transplants (KALT) increased after the implementation of the United Network of Organ Sharing (UNOS) safety net policy, but the effects of the policy on KALT outcomes remain unknown. Using the UNOS database, we identified KALT between 60 and 365 days from liver transplant from January 1, 2010, to December 31, 2020. The main outcome was 1- and 3-year patient, liver, and kidney graft survival. Secondary outcomes included 6-month and 1-year acute rejection (AR) of liver and kidney, and 1-year kidney allograft function. Of the 256 KALT, 90 were pre-policy and 166 post-policy. Compared to pre-policy, post-policy 1- and 3-year liver graft survival was higher (54% and 54% vs. 86% and 81%, respectively, p <0.001), while 1- and 3-year kidney graft survival (99% and 75% vs. 92% and 79%, respectively, p =0.19), and 1- and 3-year patient survival (99% and 99% vs. 95% and 89%, respectively, p =0.11) were not significantly different. Subgroup analysis revealed similar trends in patients with and without renal failure at liver transplant. Liver AR at 6 months was lower post-policy (6.3% vs. 18.3%, p =0.006) but was similar (10.5% vs. 13%, p =0.63) at 1 year. Kidney AR was unchanged post-policy at 6 months and 1 year. Creatinine at 1 year did not differ post-policy versus pre-policy (1.4 vs. 1.3 mg/dL, p =0.07) despite a higher proportion of deceased donors, higher Kidney Donor Profile Index, and longer kidney cold ischemia time post-policy ( p <0.05 for all). This 3-year follow-up after the 2017 UNOS policy revision demonstrated that the safety net implementation has resulted in improved liver outcomes for patients who underwent KALT with no increased AR of the liver or the kidney allografts.
自美国器官共享联合网络（UNOS）安全网政策实施以来，肝肾联合移植（KALT）后的肾脏数量有所增加，但该政策对 KALT 结果的影响尚不清楚。我们使用 UNOS 数据库，从 2010 年 1 月 1 日至 2020 年 12 月 31 日，确定了肝移植后 60 至 365 天的 KALT。主要结局是患者、肝脏和肾脏移植物 1 年和 3 年的存活率。次要结局包括肝、肾移植物 6 个月和 1 年的急性排斥反应（AR），以及 1 年的肾脏移植物功能。在 256 例 KALT 中，90 例为政策前，166 例为政策后。与政策前相比，政策后 1 年和 3 年的肝移植存活率更高（分别为 54%和 54%，86%和 81%，p <0.001），而 1 年和 3 年的肾脏移植存活率（分别为 99%和 75%，92%和 79%，p =0.19），以及 1 年和 3 年的患者存活率（分别为 99%和 99%，95%和 89%，p =0.11）均无显著差异。亚组分析显示，在肝移植时有和没有肾衰竭的患者中均存在类似的趋势。政策后 6 个月时的肝 AR 较低（6.3%比 18.3%，p =0.006），但 1 年时相似（10.5%比 13%，p =0.63）。政策后 6 个月和 1 年时的肾 AR 无变化。政策后 1 年时的血肌酐值与政策前相比无差异（1.4 比 1.3mg/dL，p =0.07），尽管政策后供体死亡比例较高，肾脏供体状况指数较高，肾脏冷缺血时间较长（p <0.05）。该研究对 2017 年 UNOS 政策修订后的 3 年随访结果表明，安全网的实施导致接受 KALT 的患者的肝脏结局得到改善，而肝和肾移植物的 AR 并未增加。
