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Delayed Graft Function in Simultaneous Liver Kidney Transplantation.
- Source :
-
Transplantation [Transplantation] 2020 Mar; Vol. 104 (3), pp. 542-550. - Publication Year :
- 2020
-
Abstract
- Background: Delayed graft function (DGF) is associated with inferior posttransplant outcomes in kidney transplantation. Given these adverse outcomes, we sought to determine the incidence, unique risk factors, and posttransplant outcomes for simultaneous liver kidney (SLK) transplant recipients developing DGF.<br />Methods: We studied 6214 adult SLK recipients from March 2002 to February 2017 using the Scientific Registry of Transplant Recipients. We determined associations between risk factors and DGF using Poisson multivariate regression and between DGF and graft failure and mortality using Cox proportional hazard analysis.<br />Results: The overall rate of DGF was 21.8%. Risk factors for DGF in the hepatitis C virus (HCV)-negative recipient population included pretransplant dialysis (adjusted incident rate ratio [aIRR] 3.26, P = 0.004), donor body mass index (aIRR 1.25 per 5 kg/m, P = 0.01), and transplantation with a donation after circulatory death (aIRR 5.38, P = 0.001) or imported donor organ (regional share aIRR 1.69, P = 0.03; national share aIRR 4.82, P < 0.001). DGF was associated with a 2.6-fold increase in kidney graft failure (adjusted hazard ratio [aHR] 2.63, P < 0.001), 1.6-fold increase in liver graft failure (aHR 1.62, P < 0.001), and 1.6-fold increase in mortality (aHR 1.62, P < 0.001).<br />Conclusions: In HCV-negative SLK recipients, recipient pretransplant dialysis and components of kidney graft quality comprise significant risk factors for DGF. Regardless of HCV status, DGF is associated with inferior posttransplant outcomes. Understanding these risk factors during clinical decision-making may improve prevention of DGF and may represent an opportunity to improve posttransplant outcomes.
- Subjects :
- Delayed Graft Function etiology
Delayed Graft Function physiopathology
End Stage Liver Disease complications
End Stage Liver Disease mortality
End Stage Liver Disease surgery
Female
Follow-Up Studies
Graft Rejection etiology
Graft Rejection physiopathology
Graft Survival
Hepacivirus isolation & purification
Humans
Kidney physiopathology
Kidney Failure, Chronic etiology
Kidney Failure, Chronic mortality
Kidney Failure, Chronic therapy
Kidney Transplantation methods
Liver physiopathology
Liver Transplantation methods
Male
Middle Aged
Proportional Hazards Models
Registries statistics & numerical data
Renal Dialysis statistics & numerical data
Retrospective Studies
Risk Factors
Tissue Donors statistics & numerical data
Transplant Recipients statistics & numerical data
Delayed Graft Function epidemiology
Graft Rejection epidemiology
Kidney Transplantation adverse effects
Liver Transplantation adverse effects
Renal Dialysis adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6080
- Volume :
- 104
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 31403551
- Full Text :
- https://doi.org/10.1097/TP.0000000000002908