Predisposing Factors of Diminished Survival in Simultaneous Liver/Kidney Transplantation

被引：34

作者：

Hibi, T. ^{[1
,2
,3
]}

Sageshima, J. ^{[1
,2
,3
]}

Molina, E. ^{[1
,2
,4
]}

Ciancio, G. ^{[1
,2
,3
]}

Nishida, S. ^{[1
,2
,3
]}

Chen, L. ^{[1
,2
,3
]}

Arosemena, L. ^{[1
,2
,4
]}

Mattiazzi, A. ^{[1
,2
,5
]}

Guerra, G. ^{[1
,2
,5
]}

Kupin, W. ^{[1
,2
,5
]}

Tekin, A. ^{[1
,2
,3
]}

Selvaggi, G. ^{[1
,2
,3
]}

Levi, D. ^{[1
,2
,3
]}

Ruiz, P. ^{[1
,2
,3
,6
]}

Livingstone, A. S. ^{[1
,2
,3
]}

Roth, D. ^{[1
,2
,5
]}

Martin, P. ^{[1
,2
,4
]}

Tzakis, A. ^{[1
,2
,3
]}

Burke, G. W. ^{[1
,2
,3
]}

机构：

[1] Univ Miami, Miami Transplant Inst, Miami, FL USA

[2] Jackson Mem Hosp, Miami, FL 33136 USA

[3] Univ Miami, Leonard M Miller Sch Med, DeWitt Daughtry Family Dept Surg, Miami, FL USA

[4] Univ Miami, Leonard M Miller Sch Med, Dept Med, Div Hepatol, Miami, FL USA

[5] Univ Miami, Leonard M Miller Sch Med, Dept Med, Div Nephrol & Hypertens, Miami, FL USA

[6] Univ Miami, Leonard M Miller Sch Med, Dept Pathol, Miami, FL USA

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2012年 / 12卷 / 11期

关键词：

Combined transplants; hepatitis C virus; kidney transplantation; liver transplantation; survival; LIVER-KIDNEY TRANSPLANTATION; VIRUS-ASSOCIATED GLOMERULONEPHRITIS; SINGLE-CENTER EXPERIENCE; DELAYED GRAFT FUNCTION; HEPATITIS-C; RENAL-ALLOGRAFTS; MYCOPHENOLATE-MOFETIL; MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS; DIABETES-MELLITUS; PATIENT SURVIVAL;

D O I：

10.1111/j.1600-6143.2012.04121.x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

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] 1.17.9), panel reactive antibody (PRA) > 20% (HR 2.8, 95% CI 1.17.2) and female donor gender (HR 2.9, 95% CI 1.17.9). For death-censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95% CI 2.527.9), followed by HCV+ and PRA > 20%. The adjusted risk of death-censored kidney graft loss in HCV+ SLKT patients was 5.8 (95% CI 1.621.6) 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.

引用

页码：2966 / 2973

页数：8

共 54 条

[1] Prevalence of hepatitis c virus-associated mixed cryoglobulinemia after liver transplantation [J].