Predisposing factors of diminished survival in simultaneous liver/kidney transplantation

T. Hibi, J. Sageshima, E. Molina, G. Ciancio, S. Nishida, L. Chen, L. Arosemena, A. Mattiazzi, G. Guerra, W. Kupin, A. Tekin, G. Selvaggi, D. Levi, P. Ruiz, A. S. Livingstone, D. Roth, P. Martin, A. Tzakis, G. W. Burke

Research output: Contribution to journalArticle

29 Scopus citations

Abstract

Since the adoption of the Model for End-Stage Liver Disease, simultaneous liver/kidney transplants (SLKT) have substantially increased. Recently, unfavorable outcomes have been reported yet contributing factors remain unclear. We retrospectively reviewed 74 consecutive adult SLKT performed at our center from 2000 to 2010 and compared with kidney transplant alone (KTA, N = 544). In SLKT, patient and death-censored kidney graft survival rates were 64 ± 6% and 81 ± 5% at 5 years, respectively (median follow-up, 47 months). Multivariable analyses revealed three independent risk factors affecting patient survival: hepatitis C virus positive (HCV+, hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.1-7.9), panel reactive antibody (PRA) > 20% (HR 2.8, 95% CI 1.1-7.2) and female donor gender (HR 2.9, 95% CI 1.1-7.9). For death-censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95% CI 2.5-27.9), followed by HCV+ and PRA > 20%. The adjusted risk of death-censored kidney graft loss in HCV+ SLKT patients was 5.8 (95% CI 1.6-21.6) compared with HCV+ KTA (p = 0.008). Recurrent HCV within 1 year after SLKT correlated with early kidney graft failure (p = 0.004). Careful donor/recipient selection and innovative approaches for HCV+ SLKT patients are critical to further improve long-term outcomes.

Original languageEnglish (US)
Pages (from-to)2966-2973
Number of pages8
JournalAmerican Journal of Transplantation
Volume12
Issue number11
DOIs
StatePublished - Nov 2012

Keywords

  • Combined transplants
  • hepatitis C virus
  • kidney transplantation
  • liver transplantation
  • survival

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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