Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Alejandro Pita, MD; Navpreet Kaur, MD; Juliet Emamaullee, MD, PhD; Mary Lo, MS; Brian Nguyen, MD; Andrew Sabour, BSc; Vincent Tristan, PA-C; Mitra Nadim, MD; Yuri Genyk, MD; Linda Sher, MD

doi:10.1097/TXD.0000000000000935

Transplantation Direct (Oct 2019)

Outcomes of Liver Transplantation in Patients on Renal Replacement Therapy: Considerations for Simultaneous Liver Kidney Transplantation Versus Safety Net

Alejandro Pita, MD,
Navpreet Kaur, MD,
Juliet Emamaullee, MD, PhD,
Mary Lo, MS,
Brian Nguyen, MD,
Andrew Sabour, BSc,
Vincent Tristan, PA-C,
Mitra Nadim, MD,
Yuri Genyk, MD,
Linda Sher, MD

Affiliations

Alejandro Pita, MD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Navpreet Kaur, MD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Juliet Emamaullee, MD, PhD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Mary Lo, MS: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Brian Nguyen, MD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Andrew Sabour, BSc: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Vincent Tristan, PA-C: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Mitra Nadim, MD: 3 Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, CA.
Yuri Genyk, MD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
Linda Sher, MD: 1 Division of Hepatobiliary and Abdominal Transplant Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.

DOI: https://doi.org/10.1097/TXD.0000000000000935
Journal volume & issue: Vol. 5, no. 10
p. e490

Abstract

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Background. As the liver transplant (LT) waiting list continues to outpace organ availability, many patients require renal replacement therapy (RRT) before LT. It is unclear which patients will benefit from simultaneous liver kidney (SLK) transplant as opposed to awaiting a Safety Net kidney transplant (KT) post-LT. Methods. In this study, a retrospective analysis of the United Network for Organ Sharing dataset was performed to identify risk factors associated with poor outcome for patients on RRT before LT who were listed for SLK and received either SLK vs LT alone (LTA). Results. Between January 2003 and December 2016, 8971 adult LT recipients were on RRT at the time of LT. 5359 were listed for and received LTA (Group 1). Of 3612 patients listed for SLK, 3414 (38.1%) received SLK (Group 2) and 198 (2.2%) received LTA (Group 3). Overall, Group 3 had lower graft and patient survival post-LT when compared with Groups 1 and 2 (P 60 (P 90 days; P = 0.001) were associated with lower patient survival in Group 3. Conclusions. Among LT recipients on RRT before LT who were listed for SLK, RRT >90 days, and age >60 were associated with poor outcome following LTA. This suggests that programs should carefully weigh the decision to proceed with LTA vs waiting for SLK in this patient population. Future access to Safety Net KT will be an important consideration for these patients moving forward.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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