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

Abstract

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.

Excellent outcomes in combined liver‐kidney transplantation: Impact of kidney donor profile index and delayed kidney transplantation

“…The delayed approach KT, as explained above. Korayem et al have recently shown that hypothermic pulsatile machine perfusion of kidney allografts plays a key role in preventing DGF among patient listed for CLKT, confirming our findings.…”

Is Prioritization of Kidney Allografts to Combined Liver-Kidney Recipients Appropriate? COMMENTARY

“…Korayem et al in their single center retrospective review of nearly 200 SLKT recipients found the incidence of kDGF (defined as dialysis requirement in the first week following SLKT) to be 49%. 14 Many factors, both donor and recipient derived, contributed to this significantly higher rate of kDGF in comparison to the rate in KTA. But notably, kidney function at three and twelve months following SLKT was inferior in the SLKT recipients with kDGF compared with those who experienced immediate function.…”

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.…”

“…[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.…”