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Impact of Donation After Circulatory Death Allografts on Outcomes Following Simultaneous Liver-Kidney Transplant: A Single-Center Experience and Review of the Literature.
Kumar, Shiva; Pedersen, Rachel; Sahajpal, Ajay.
Afiliación
  • Kumar S; From the Department of Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
  • Pedersen R; From the Transplant Center, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA.
Exp Clin Transplant ; 21(4): 299-306, 2023 04.
Article en En | MEDLINE | ID: mdl-37154590
OBJECTIVES: Limited data exist on outcomes after simultaneous liver-kidney transplants with extended criteria donor grafts. We compared outcomes in recipients of simultaneous liver-kidney transplants with donation after circulatory death versus donation after brain death grafts. MATERIALS AND METHODS: This retrospective analysis included all liver transplants performed over a 7-year period at a single center. We compared categorical variables using the chi-square test and continuous variables using the t test. We compared survival using the Kaplan-Meier method and performed a univariate analysis of predictors of outcomes using Cox regression method. RESULTS: Over the study period, 196 patients underwent liver transplant, with 33 (16.8%) undergoing simultaneous liver-kidney transplant. In this cohort, 23 and 10 patients, respectively, received grafts from donors after brain death versus circulatory death. Both groups were comparable with respect to age, sex, hepatitis C virus status, and presence of hepatocellular carcinoma. Median (range) Model for End-Stage Liver Disease score was higher in recipients of donation after brain death grafts (37 [26-40] vs 23 [21-24]; P < .01). Liver allograft survival was comparable in donation after brain death versus donation after circulatory death recipients (P = .82) at 1 year (64.0% vs 66.7%), 3 years (57.6% vs 55.6%), and 5 years (57.6% vs 55.6%). Patient survival was also comparable (P = .89) at 1 year (70.1% vs 77.8%), 3 years (63.1% vs 55.6%), and 5 years (63.1% vs 55.6%). Graft outcomes remained similar even after adjustment for Model for End-Stage Liver Disease score at transplant (hazard ratio 0.58; 95% CI, 0.14-2.44; P = .45). Univariate analysis of predictors of patient survival after simultaneous liver- kidney transplant showed a trend toward statistical significance with recipient age and donor male sex. CONCLUSIONS: Grafts from donors after circulatory death could help safely expand the donor pool in patients undergoing simultaneous liver-kidney transplant without compromising outcomes.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obtención de Tejidos y Órganos / Trasplante de Riñón / Trasplante de Hígado / Enfermedad Hepática en Estado Terminal / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: Exp Clin Transplant Asunto de la revista: TRANSPLANTE Año: 2023 Tipo del documento: Article País de afiliación: Emiratos Árabes Unidos Pais de publicación: Turquía

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Obtención de Tejidos y Órganos / Trasplante de Riñón / Trasplante de Hígado / Enfermedad Hepática en Estado Terminal / Neoplasias Hepáticas Tipo de estudio: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Male Idioma: En Revista: Exp Clin Transplant Asunto de la revista: TRANSPLANTE Año: 2023 Tipo del documento: Article País de afiliación: Emiratos Árabes Unidos Pais de publicación: Turquía