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Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience

Combined liver–kidney transplantation (CLKT) improves patient survival among liver transplant recipients with renal dysfunction. However, kidney delayed graft function (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study...

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Autores principales: Vincenzi, Paolo, Gaynor, Jeffrey J., Vianna, Rodrigo, Ciancio, Gaetano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146237/
https://www.ncbi.nlm.nih.gov/pubmed/35628851
http://dx.doi.org/10.3390/jcm11102724
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author Vincenzi, Paolo
Gaynor, Jeffrey J.
Vianna, Rodrigo
Ciancio, Gaetano
author_facet Vincenzi, Paolo
Gaynor, Jeffrey J.
Vianna, Rodrigo
Ciancio, Gaetano
author_sort Vincenzi, Paolo
collection PubMed
description Combined liver–kidney transplantation (CLKT) improves patient survival among liver transplant recipients with renal dysfunction. However, kidney delayed graft function (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study analyzed the incidence, potential risk factors, and prognostic impact of kDGF development following CLKT in a recently transplanted cohort. Specifically, 115 consecutive CLKT recipients who were transplanted at our center between January 2015 and February 2021 were studied. All transplanted kidneys received hypothermic pulsatile machine perfusion (HPMP) prior to transplant. The primary outcome was kDGF development. Secondary outcomes included the combined incidence and severity of developing postoperative complications; development of postoperative infections; biopsy-proven acute rejection (BPAR); renal function at 1, 3, 6, and 12 months post-transplant; and death-censored graft and patient survival. kDGF was observed in 37.4% (43/115) of patients. Multivariable analysis of kDGF revealed the following independent predictors: preoperative dialysis (p = 0.0003), lower recipient BMI (p = 0.006), older donor age (p = 0.003), utilization of DCD donors (p = 0.007), and longer delay of kidney transplantation after liver transplantation (p = 0.0003). With a median follow-up of 36.7 months post-transplant, kDGF was associated with a significantly increased risk of developing more severe postoperative complication(s) (p < 0.000001), poorer renal function (particularly at 1 month post-transplant, p < 0.000001), and worse death-censored graft (p = 0.00004) and patient survival (p = 0.0002). kDGF may be responsible for remarkable negative effects on immediate and potentially longer-term clinical outcomes after CLKT. Understanding the important risk factors for kDGF development in CLKT may better guide recipient and donor selection(s) and improve clinical decisions in this increasing group of transplant recipients.
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spelling pubmed-91462372022-05-29 Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience Vincenzi, Paolo Gaynor, Jeffrey J. Vianna, Rodrigo Ciancio, Gaetano J Clin Med Article Combined liver–kidney transplantation (CLKT) improves patient survival among liver transplant recipients with renal dysfunction. However, kidney delayed graft function (kDGF) still represents a common and challenging complication that can negatively impact clinical outcomes. This retrospective study analyzed the incidence, potential risk factors, and prognostic impact of kDGF development following CLKT in a recently transplanted cohort. Specifically, 115 consecutive CLKT recipients who were transplanted at our center between January 2015 and February 2021 were studied. All transplanted kidneys received hypothermic pulsatile machine perfusion (HPMP) prior to transplant. The primary outcome was kDGF development. Secondary outcomes included the combined incidence and severity of developing postoperative complications; development of postoperative infections; biopsy-proven acute rejection (BPAR); renal function at 1, 3, 6, and 12 months post-transplant; and death-censored graft and patient survival. kDGF was observed in 37.4% (43/115) of patients. Multivariable analysis of kDGF revealed the following independent predictors: preoperative dialysis (p = 0.0003), lower recipient BMI (p = 0.006), older donor age (p = 0.003), utilization of DCD donors (p = 0.007), and longer delay of kidney transplantation after liver transplantation (p = 0.0003). With a median follow-up of 36.7 months post-transplant, kDGF was associated with a significantly increased risk of developing more severe postoperative complication(s) (p < 0.000001), poorer renal function (particularly at 1 month post-transplant, p < 0.000001), and worse death-censored graft (p = 0.00004) and patient survival (p = 0.0002). kDGF may be responsible for remarkable negative effects on immediate and potentially longer-term clinical outcomes after CLKT. Understanding the important risk factors for kDGF development in CLKT may better guide recipient and donor selection(s) and improve clinical decisions in this increasing group of transplant recipients. MDPI 2022-05-11 /pmc/articles/PMC9146237/ /pubmed/35628851 http://dx.doi.org/10.3390/jcm11102724 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Vincenzi, Paolo
Gaynor, Jeffrey J.
Vianna, Rodrigo
Ciancio, Gaetano
Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title_full Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title_fullStr Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title_full_unstemmed Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title_short Predictors of Kidney Delayed Graft Function and Its Prognostic Impact following Combined Liver–Kidney Transplantation: A Recent Single-Center Experience
title_sort predictors of kidney delayed graft function and its prognostic impact following combined liver–kidney transplantation: a recent single-center experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9146237/
https://www.ncbi.nlm.nih.gov/pubmed/35628851
http://dx.doi.org/10.3390/jcm11102724
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