Factors predicting kidney delayed graft function among recipients of simultaneous liver-kidney transplantation: A single-center experience

被引:8
|
作者
Korayem, Islam M. [1 ,2 ]
Agopian, Vatche G. [1 ]
Lunsford, Keri E. [3 ]
Gritsch, Hans A. [4 ]
Veale, Jeffrey L. [4 ]
Lipshutz, Gerald S. [1 ,4 ]
Yersiz, Hasan [1 ]
Serrone, Coney L. [1 ]
Kaldas, Fady M. [1 ]
Farmer, Douglas G. [1 ]
Bunnapradist, Suphamai [5 ]
Danovitch, Gabriel M. [5 ]
Busuttil, Ronald W. [1 ]
Zarrinpar, Ali [6 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Dumont UCLA Transplant Ctr,Div Liver & Pancreas T, Los Angeles, CA 90095 USA
[2] Univ Alexandria, Dept Surg, Hepatopancreatobiliary & Liver Transplantat Surg, Fac Med, Alexandria, Egypt
[3] Houston Methodist Hosp, Weill Cornell Med Coll, Sherrie & Alan Conover Ctr Liver Dis & Transplant, JC Walter Jr Transplant Ctr, Houston, TX USA
[4] Univ Calif Los Angeles, David Geffen Sch Med, Dept Urol, Los Angeles, CA 90095 USA
[5] Univ Calif Los Angeles, David Geffen Sch Med, Div Nephrol, Los Angeles, CA 90095 USA
[6] Univ Florida, Div Transplantat & Hepatobiliary Surg, 1600 SW Archer Rd, Gainesville, FL 32610 USA
关键词
delayed graft function (DGF); dysfunction; kidney (allograft) function; organ perfusion and preservation; COLD ISCHEMIA TIME; MACHINE PERFUSION; RENAL-FUNCTION; RISK-FACTORS; PULSATILE PERFUSION; PATIENT SURVIVAL; UNITED NETWORK; STORAGE; DISEASE; PRESERVATION;
D O I
10.1111/ctr.13569
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Kidney delayed graft function (kDGF) remains a challenging problem following simultaneous liver and kidney transplantation (SLKT) with a reported incidence up to 40%. Given the scarcity of renal allografts, it is crucial to minimize the development of kDGF among SLKT recipients to improve patient and graft outcomes. We sought to assess the role of preoperative recipient and donor/graft factors on developing kDGF among recipients of SLKT. Methods A retrospective review of 194 patients who received SLKT in the period from January 2004 to March 2017 in a single center was performed to assess the effect of preoperative factors on the development of kDGF. Results Kidney delayed graft function was observed in 95 patients (49%). Multivariate analysis revealed that donor history of hypertension, cold static preservation of kidney grafts [versus using hypothermic pulsatile machine perfusion (HPMP)], donor final creatinine, physiologic MELD, and duration of delay of kidney transplantation after liver transplantation were significant independent predictors for kDGF. kDGF is associated with worse graft function and patient and graft survival. Conclusions Kidney delayed graft function has detrimental effects on graft function and graft survival. Understanding the risks and combining careful perioperative patient management, proper recipient selection and donor matching, and graft preservation using HPMP would decrease kDGF among SLKT recipients.
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页数:12
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