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Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver–Kidney Transplantation

Lunsford, Keri E ; Agopian, Vatche G ; Yi, Stephanie G ; Nguyen, Duc T.M ; Graviss, Edward A ; Harlander-Locke, Michael P ; Saharia, Ashish ; Kaldas, Fady M ; Mobley, Constance M ; Zarrinpar, Ali ; Hobeika, Mark J ; Veale, Jeffrey L ; Podder, Hemangshu ; Farmer, Douglas G ; Knight, Richard J ; Danovitch, Gabriel M ; Gritsch, H Albin ; Li, Xian C ; Ghobrial, R Mark ; Busuttil, Ronald W ; Gaber, A Osama

Transplantation, 2020-08, Vol.104 (8), p.1591-1603 [Periódico revisado por pares]

United States: Copyright Wolters Kluwer Health, Inc. All rights reserved

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Título:
Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver–Kidney Transplantation
Autor: Lunsford, Keri E ; Agopian, Vatche G ; Yi, Stephanie G ; Nguyen, Duc T.M ; Graviss, Edward A ; Harlander-Locke, Michael P ; Saharia, Ashish ; Kaldas, Fady M ; Mobley, Constance M ; Zarrinpar, Ali ; Hobeika, Mark J ; Veale, Jeffrey L ; Podder, Hemangshu ; Farmer, Douglas G ; Knight, Richard J ; Danovitch, Gabriel M ; Gritsch, H Albin ; Li, Xian C ; Ghobrial, R Mark ; Busuttil, Ronald W ; Gaber, A Osama
Assuntos: Aged ; Allografts - immunology ; Allografts - supply & distribution ; Cold Ischemia - instrumentation ; Cold Ischemia - methods ; Cold Ischemia - statistics & numerical data ; End Stage Liver Disease - complications ; End Stage Liver Disease - surgery ; Feasibility Studies ; Female ; Graft Rejection - epidemiology ; Graft Rejection - immunology ; Graft Rejection - prevention & control ; Graft Survival - immunology ; Humans ; Kidney - immunology ; Kidney Transplantation - adverse effects ; Kidney Transplantation - ethics ; Kidney Transplantation - methods ; Kidney Transplantation - statistics & numerical data ; Liver Transplantation - adverse effects ; Liver Transplantation - ethics ; Liver Transplantation - methods ; Liver Transplantation - statistics & numerical data ; Male ; Medical Futility - ethics ; Middle Aged ; Organ Preservation - instrumentation ; Organ Preservation - methods ; Organ Preservation - statistics & numerical data ; Perfusion - instrumentation ; Perfusion - methods ; Perfusion - statistics & numerical data ; Renal Insufficiency - etiology ; Renal Insufficiency - surgery ; Retrospective Studies ; Time Factors ; Time-to-Treatment - statistics & numerical data ; Transplantation, Homologous - adverse effects ; Transplantation, Homologous - ethics ; Transplantation, Homologous - methods ; Treatment Outcome
É parte de: Transplantation, 2020-08, Vol.104 (8), p.1591-1603
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SourceType-Scholarly Journals-1
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Descrição: BACKGROUND.Combined liver–kidney transplantation (CLKT) improves survival for liver transplant recipients with renal dysfunction; however, the tenuous perioperative hemodynamic and metabolic milieu in high-acuity CLKT recipients increases delayed graft function and kidney allograft failure. We sought to analyze whether delayed KT through pumping would improve kidney outcomes following CLKT. METHODS.A retrospective analysis (University of California Los Angeles [n = 145], Houston Methodist Hospital [n = 79]) was performed in all adults receiving CLKT at 2 high-volume transplant centers from February 2004 to January 2017, and recipients were analyzed for patient and allograft survival as well as renal outcomes following CLKT. RESULTS.A total of 63 patients (28.1%) underwent delayed implantation of pumped kidneys during CLKT (dCLKT) and 161 patients (71.9%) received early implantation of nonpumped kidneys during CLKT (eCLKT). Most recipients were high-acuity with median biologic model of end-stage liver disease (MELD) score of, 35 for dCLKT and 34 for eCLKT (P = ns). Pretransplant, dCLKT had longer intensive care unit stay, were more often intubated, and had greater vasopressor use. Despite this, dCLKT exhibited improved 1-, 3-, and 5-year patient and kidney survival (P = 0.02) and decreased length of stay (P = 0.001), kidney allograft failure (P = 0.012), and dialysis duration (P = 0.031). This reduced kidney allograft futility (death or continued need for hemodialysis within 3 mo posttransplant) for dCLKT (6.3%) compared with eCLKT (19.9%) (P = 0.013). CONCLUSIONS.Delayed implantation of pumped kidneys is associated with improved patient and renal allograft survival and decreased hospital length of stay despite longer kidney cold ischemia. These data should inform the ethical debate as to the futility of performing CLKT in high-acuity recipients.
Editor: United States: Copyright Wolters Kluwer Health, Inc. All rights reserved
Idioma: Inglês

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Delayed Implantation of Pumped Kidneys Decreases Renal Allograft Futility in Combined Liver–Kidney Transplantation

United States: Copyright Wolters Kluwer Health, Inc. All rights reserved

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