Simultaneous Liver–Kidney Transplantation Summit: Current State and Future Directions

Nadim, Mitra K.; Sung, Randall S.; Davis, Connie L.; Andreoni, Kenneth A.; Biggins, Scott W.; Danovitch, Gabriel M.; Feng, Sandy; Friedewald, John; Hong, Johnny C.; Kellum, John A.; Kim, Woojin; Lake, John R.; Melton, L. A.; Pomfret, Elizabeth A.; Saab, Sammy; Genyk, Yuri

doi:10.1111/j.1600-6143.2012.04190.x

Cited by 232 publications

(243 citation statements)

References 28 publications

(32 reference statements)

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“…A recent survey of US transplant centers demonstrated significant variation in the criteria used for SLKT among transplant centers (19). Approximately 73% of transplant centers took dialysis duration into account when selecting candidates with AKI for SLKT; however, pre-LT RRT duration varied among the transplant centers (.4, .6, .8 weeks of RRT) (20).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Sharma

Goodrich

Zhang

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Candidates with AKI including hepatorenal syndrome often recover renal function after successful liver transplantation (LT). This study examined the incidence and risk factors associated with renal nonrecovery within 6 months of LT alone among those receiving acute renal replacement therapy (RRT) before LT.Design, setting, participants, & measurements Scientific Registry of Transplant Recipients data were linked with Centers for Medicare and Medicaid Services ESRD data for 2112 adult deceased-donor LT-alone recipients who received acute RRT for #90 days before LT (February 28, 2002 to August 31, 2010. Primary outcome was renal nonrecovery (post-LT ESRD), defined as transition to chronic dialysis or waitlisting or receipt of kidney transplant within 6 months of LT. Cumulative incidence of renal nonrecovery was calculated using competing risk analysis. Cox regression identified recipient and donor predictors of renal nonrecovery.Results The cumulative incidence of renal nonrecovery after LT alone among those receiving the pre-LT acute RRT was 8.9%. Adjusted renal nonrecovery risk increased by 3.6% per day of pre-LT RRT (P,0.001). Age at LT per 5 years (P=0.02), previous-LT (P=0.01), and pre-LT diabetes (P,0.001) were significant risk factors of renal nonrecovery. Twenty-one percent of recipients died within 6 months of LT. Duration of pretransplant RRT did not predict 6-month post-transplant mortality.Conclusions Among recipients on acute RRT before LT who survived after LT alone, the majority recovered their renal function within 6 months of LT. Longer pre-LT RRT duration, advanced age, diabetes, and re-LT were significantly associated with increased risk of renal nonrecovery.

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Section: Discussionmentioning

confidence: 99%

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Sharma

Goodrich

Zhang

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…56,57 However, post-transplant outcomes have not worsened in the MELD era. 57,58 Increasing use of SLK has raised concern about the shortage of donor kidneys.…”

Section: Model For End-stage Liver Disease and Simultaneous Kidney Trmentioning

confidence: 99%

Model for End-stage Liver Disease

Singal

Kamath

2013

Journal of Clinical and Experimental Hepatology

124

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“…In 2006, 2007, and 2012, several transplant societies held consensus conferences to discuss the topic and began to formulate medical criteria for SLK (3,10,11). In 2009, the Kidney Transplantation and Liver and Intestinal Transplantation Committees distributed a public comment proposal that was largely constructed from these recommendations.…”

Section: Past Workmentioning

confidence: 99%

“…Also contributing to the increasing trend is the fact that there are no medical criteria on which allocation of the kidney with a liver is based. This has resulted in heterogeneity in both numbers of SLK transplants performed in the different OPTN regions of the country and which patients receive them (3). The primary issue driving SLK allocation is increasing severity of illness of liver disease patients.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Liver–Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

Formica

Aeder

Boyle³

et al. 2016

American Journal of Transplantation

159

194

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The introduction of the Mayo End-Stage Liver Disease score into the Organ Procurement and Transplantation Network (OPTN) deceased donor liver allocation policy in 2002 has led to a significant increase in the number of simultaneous liver-kidney transplants in the United States. Despite multiple attempts, clinical science has not been able to reliably predict which liver candidates with renal insufficiency will recover renal function or need a concurrent kidney transplant. The problem facing the transplant community is that currently there are almost no medical criteria for candidacy for simultaneous liver-kidney allocation in the United States, and this lack of standardized rules and medical eligibility criteria for kidney allocation with a liver is counter to OPTN's Final Rule. Moreover, almost 50% of simultaneous liver-kidney organs come from a donor with a kidney donor profile index of ≤0.35. The kidneys from these donors could otherwise be allocated to pediatric recipients, young adults or prior organ donors. This paper presents the new OPTN and United Network of Organ Sharing simultaneous liver-kidney allocation policy, provides the supporting evidence and explains the rationale on which the policy was based.

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Simultaneous Liver–Kidney Transplantation Summit: Current State and Future Directions

Cited by 232 publications

References 28 publications

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Short-Term Pretransplant Renal Replacement Therapy and Renal Nonrecovery after Liver Transplantation Alone

Model for End-stage Liver Disease

Simultaneous Liver–Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

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