A Single-Center Assessment of Delayed Graft Function in Recipients of Simultaneous Liver and Kidney Transplant

Abstract

Background: The effects of delayed graft function on long-term kidney allograft outcomes are poorly defined among simultaneous liver and kidney transplant recipients. Methods: We analyzed data of all simultaneous liver and kidney recipients transplanted at the University of Wisconsin between 2010 and 2017. Risk factors for the development of delayed graft function, kidney graft failure, and patient mortality were outcomes of interest. Results: There were a total of 60 simultaneous liver and kidney recipients; 28 (47%) had delayed graft function. After adjustment for multiple variables, we found that pretransplant dialysis >6 weeks (hazard ratio [HR] = 5.6, 95% CI: 1.23-25.59, P = .02), pretransplant albumin <3 g/dL (HR = 5.75, 95% CI: 1.76-16.94, P = .003), and presence of pretransplant diabetes (HR = 2.5, 95% CI: 0.97-4.77, P = .05) were significantly associated with delayed graft function. Multivariate analysis showed that pretransplant albumin <3 (HR = 4.86, 95% CI: 1.07-22.02, P = .02) was associated with a higher risk of all-cause kidney allograft failure, whereas the duration of delayed graft function (HR = 1.07 per day, 95% CI: 1.01-1.14, P = .01) was associated with a higher risk of death-censored kidney allograft failure. The presence of delayed graft function was not associated with all-cause or death-censored kidney or liver allograft failure. Similarly, the presence of delayed graft function was not associated with patient mortality. Conclusion: The incidence of delayed graft function was high in simultaneous liver and kidney recipients. However, with appropriate management, delayed graft function may not have a negative impact on patient or kidney allograft survival.

Immunology of simultaneous liver and kidney transplants with identification and prevention of rejection

“…Similar to kidney-only transplant recipients, the negative impact DGF among SLK recipients has been reported by Weeks et al ( 61 ). However, another small single-center study did not find any impact on patient or allograft survival among SLK recipients with DGF ( 62 ). Similar to the kidney-only transplant recipients, the risk of kidney DGF were similar among SLK recipients with most common risk being use of donation after circulatory death organs, national sharing of organs in reference to the local, pre-transplant dialysis need and duration, and higher donor body mass index ( 61 ).…”

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

“…This is usually preceded by the most common phenomenon of kidney DGF, which has been reported in 47 to 49% of patients. [111][112][113] Historically, DGF had been linked to kidney and liver graft failure as well as overall mortality. 112,114,115 However, more recent data have countered this observation.…”

“…DGF does not affect progression of allograft fibrosis in KTA 116 and in a recent series of 60 SLK patients, DGF was neither associated with all-cause, nor death-censored, failure of the liver or kidney graft, nor with patient survival, but the duration of kidney DGF was a predictor of death-censored kidney allograft failure. 113 Interestingly, in KTA, interleukin-18 and urinary NGAL are associated with DGF, 117 and this is an area which can be analyzed in SLK outcomes as well.…”