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Abstract: FR-PO806

Predictors of Kidney Delayed Graft Function and Its Prognostic Impact Following Combined Liver-Kidney Transplantation

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Vincenzi, Paolo, Miami Transplant Institute, Miami, Florida, United States
  • Gaynor, Jeffrey J., Miami Transplant Institute, Miami, Florida, United States
  • Ciancio, Gaetano, Miami Transplant Institute, Miami, Florida, United States

Group or Team Name

  • Miami Transplant Institute
Background

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.

Methods

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.

Results

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=.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(P<0.000001), and worse death-censored graft(P=.00004) and patient survival(P=.0002).

Conclusion

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.