Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

Bekir Tanriover, Malcolm P. MacConmara, Justin Parekh, Cristina Arce, Song Zhang, Ang Gao, Arjmand Mufti, Swee Ling Levea, Burhaneddin Sandikci, Mehmet U S Ayvaci, Venketash K. Ariyamuthu, Christine Hwang, Sumit Mohan, Mutlu Mete, Miguel A. Vazquez, Jorge A. Marrero

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Abstract

Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.

Original languageEnglish (US)
Pages (from-to)221-229
Number of pages9
JournalKidney International Reports
Volume1
Issue number4
DOIs
StatePublished - 2016

Fingerprint

Liver Transplantation
Kidney Transplantation
Dialysis
Creatinine
Transplants
Kidney
Survival
Liver
Tissue Donors
Propensity Score
Mortality
Serum
Proportional Hazards Models
Chronic Kidney Failure
Renal Insufficiency
Registries
Cohort Studies
Transplantation
Confidence Intervals
Incidence

Keywords

  • deceased donor quality
  • dual organ allocation
  • propensity score matching
  • simultaneous liver-kidney transplantation
  • UNOS

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{814555b10b2b4d53a0908a7c6d3ced1a,
title = "Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival",
abstract = "Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95{\%} confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7{\%} in SLK vs. 7.6{\%} in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.",
keywords = "deceased donor quality, dual organ allocation, propensity score matching, simultaneous liver-kidney transplantation, UNOS",
author = "Bekir Tanriover and MacConmara, {Malcolm P.} and Justin Parekh and Cristina Arce and Song Zhang and Ang Gao and Arjmand Mufti and Levea, {Swee Ling} and Burhaneddin Sandikci and Ayvaci, {Mehmet U S} and Ariyamuthu, {Venketash K.} and Christine Hwang and Sumit Mohan and Mutlu Mete and Vazquez, {Miguel A.} and Marrero, {Jorge A.}",
year = "2016",
doi = "10.1016/j.ekir.2016.07.008",
language = "English (US)",
volume = "1",
pages = "221--229",
journal = "Kidney International Reports",
issn = "2468-0249",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction

T2 - Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

AU - Tanriover, Bekir

AU - MacConmara, Malcolm P.

AU - Parekh, Justin

AU - Arce, Cristina

AU - Zhang, Song

AU - Gao, Ang

AU - Mufti, Arjmand

AU - Levea, Swee Ling

AU - Sandikci, Burhaneddin

AU - Ayvaci, Mehmet U S

AU - Ariyamuthu, Venketash K.

AU - Hwang, Christine

AU - Mohan, Sumit

AU - Mete, Mutlu

AU - Vazquez, Miguel A.

AU - Marrero, Jorge A.

PY - 2016

Y1 - 2016

N2 - Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.

AB - Introduction The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 2 mg/dl at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, P = 0.005). The decrease in mortality was observed among SLK recipients with better quality donors (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.

KW - deceased donor quality

KW - dual organ allocation

KW - propensity score matching

KW - simultaneous liver-kidney transplantation

KW - UNOS

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U2 - 10.1016/j.ekir.2016.07.008

DO - 10.1016/j.ekir.2016.07.008

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