Simultaneous liver–kidney transplantation from donation after cardiac death donors: an updated perspective

Abstract

Early experiences with both liver and kidney donation after cardiac (DCD) allografts showed outcomes that were inferior to those for donation after brain death (DBD) donors. Concerns specific to DCD kidney allografts included prolonged delayed graft function (DGF), ischemia-reperfusion injury leading to allograft fibrosis, and primary nonfunction (PNF). 1-4 Similarly, decreased survival

Ischemic Cholangiopathy Postdonation After Circulatory Death Liver Transplantation: Donor Hepatectomy Time Matters

“…26 Eleven patients in our cohort underwent SLK with a 1-y renal allograft survival of 72.7% that is lower than more contemporary reports. 27,28 All 3 graft losses occurred because of patient death; 2 of them happened early on in our experience (2005 and 2009) and were the result of graft versus host disease in 1 patient and cardiopulmonary arrest in the other.…”

Successful outcomes with transplanting kidneys from deceased donors with acute kidney injuryon temporary renal replacement therapy

“…There is always a concern about severe AKI resulting in fibrosis, but we do not see evidence in this cohort, likely due to younger donor age, lack of chronic changes seen on time 0 biopsy, and the possible effect of ischemic preconditioning 22,23 . Renal function was similar after month 1 in all 3 study groups.…”

“…There is always a concern about severe AKI resulting in fibrosis, but we do not see evidence in this cohort, likely due to younger donor age, lack of chronic changes seen on time 0 biopsy, and the possible effect of ischemic preconditioning. 22,23 Renal function was similar after month 1 in all 3 study groups. In previous studies, we have shown that the biomarkers of initial injury associated with kidneys from donors with AKI were transient and had resolved by 4 months.…”

Current and Evolving Indications for Simultaneous Liver Kidney Transplantation

“…123,124 Furthermore, the presence of DGF did not ultimately affect kidney or liver graft outcomes in patients transplanted with organs from donors with either brain death or cardiac death. 123 Thus, this encouraging data may help propel larger centers to reconsider the use of SLK DCD. Finally, use of DCD kidneys in combination with delayed implementation could potentially be an area in which the field of SLK evolves.…”

“…122 Fortunately, more recent larger scale data demonstrate similar kidney graft and liver graft survival as well as overall patient survival for DCD SLK as compared with DBD of similar era. 123,124 Furthermore, the presence of DGF did not ultimately affect kidney or liver graft outcomes in patients transplanted with organs from donors with either brain death or cardiac death. 123 Thus, this encouraging data may help propel larger centers to reconsider the use of SLK DCD.…”