Predisposing factors of diminished survival in simultaneous liver/kidney transplantation

T. Hibi, Junichiro Sageshima, E. Molina, G. Ciancio, S. Nishida, L. Chen, L. Arosemena, A. Mattiazzi, G. Guerra, W. Kupin, A. Tekin, G. Selvaggi, D. Levi, P. Ruiz, A. S. Livingstone, D. Roth, P. Martin, A. Tzakis, G. W. Burke

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Since the adoption of the Model for End-Stage Liver Disease, simultaneous liver/kidney transplants (SLKT) have substantially increased. Recently, unfavorable outcomes have been reported yet contributing factors remain unclear. We retrospectively reviewed 74 consecutive adult SLKT performed at our center from 2000 to 2010 and compared with kidney transplant alone (KTA, N = 544). In SLKT, patient and death-censored kidney graft survival rates were 64 ± 6% and 81 ± 5% at 5 years, respectively (median follow-up, 47 months). Multivariable analyses revealed three independent risk factors affecting patient survival: hepatitis C virus positive (HCV+, hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.1-7.9), panel reactive antibody (PRA) > 20% (HR 2.8, 95% CI 1.1-7.2) and female donor gender (HR 2.9, 95% CI 1.1-7.9). For death-censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95% CI 2.5-27.9), followed by HCV+ and PRA > 20%. The adjusted risk of death-censored kidney graft loss in HCV+ SLKT patients was 5.8 (95% CI 1.6-21.6) compared with HCV+ KTA (p = 0.008). Recurrent HCV within 1 year after SLKT correlated with early kidney graft failure (p = 0.004). Careful donor/recipient selection and innovative approaches for HCV+ SLKT patients are critical to further improve long-term outcomes.

Original languageEnglish (US)
Pages (from-to)2966-2973
Number of pages8
JournalAmerican Journal of Transplantation
Volume12
Issue number11
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

Fingerprint

Causality
Liver Transplantation
Kidney Transplantation
Kidney
Transplants
Survival
Confidence Intervals
Liver
Graft Survival
Delayed Graft Function
Donor Selection
End Stage Liver Disease
Antibodies
Hepacivirus
Renal Insufficiency
Survival Rate
Tissue Donors

Keywords

  • Combined transplants
  • hepatitis C virus
  • kidney transplantation
  • liver transplantation
  • survival

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Predisposing factors of diminished survival in simultaneous liver/kidney transplantation. / Hibi, T.; Sageshima, Junichiro; Molina, E.; Ciancio, G.; Nishida, S.; Chen, L.; Arosemena, L.; Mattiazzi, A.; Guerra, G.; Kupin, W.; Tekin, A.; Selvaggi, G.; Levi, D.; Ruiz, P.; Livingstone, A. S.; Roth, D.; Martin, P.; Tzakis, A.; Burke, G. W.

In: American Journal of Transplantation, Vol. 12, No. 11, 01.11.2012, p. 2966-2973.

Research output: Contribution to journalArticle

Hibi, T, Sageshima, J, Molina, E, Ciancio, G, Nishida, S, Chen, L, Arosemena, L, Mattiazzi, A, Guerra, G, Kupin, W, Tekin, A, Selvaggi, G, Levi, D, Ruiz, P, Livingstone, AS, Roth, D, Martin, P, Tzakis, A & Burke, GW 2012, 'Predisposing factors of diminished survival in simultaneous liver/kidney transplantation', American Journal of Transplantation, vol. 12, no. 11, pp. 2966-2973. https://doi.org/10.1111/j.1600-6143.2012.04121.x
Hibi, T. ; Sageshima, Junichiro ; Molina, E. ; Ciancio, G. ; Nishida, S. ; Chen, L. ; Arosemena, L. ; Mattiazzi, A. ; Guerra, G. ; Kupin, W. ; Tekin, A. ; Selvaggi, G. ; Levi, D. ; Ruiz, P. ; Livingstone, A. S. ; Roth, D. ; Martin, P. ; Tzakis, A. ; Burke, G. W. / Predisposing factors of diminished survival in simultaneous liver/kidney transplantation. In: American Journal of Transplantation. 2012 ; Vol. 12, No. 11. pp. 2966-2973.
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abstract = "Since the adoption of the Model for End-Stage Liver Disease, simultaneous liver/kidney transplants (SLKT) have substantially increased. Recently, unfavorable outcomes have been reported yet contributing factors remain unclear. We retrospectively reviewed 74 consecutive adult SLKT performed at our center from 2000 to 2010 and compared with kidney transplant alone (KTA, N = 544). In SLKT, patient and death-censored kidney graft survival rates were 64 ± 6{\%} and 81 ± 5{\%} at 5 years, respectively (median follow-up, 47 months). Multivariable analyses revealed three independent risk factors affecting patient survival: hepatitis C virus positive (HCV+, hazard ratio [HR] 2.9, 95{\%} confidence interval [CI] 1.1-7.9), panel reactive antibody (PRA) > 20{\%} (HR 2.8, 95{\%} CI 1.1-7.2) and female donor gender (HR 2.9, 95{\%} CI 1.1-7.9). For death-censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95{\%} CI 2.5-27.9), followed by HCV+ and PRA > 20{\%}. The adjusted risk of death-censored kidney graft loss in HCV+ SLKT patients was 5.8 (95{\%} CI 1.6-21.6) compared with HCV+ KTA (p = 0.008). Recurrent HCV within 1 year after SLKT correlated with early kidney graft failure (p = 0.004). Careful donor/recipient selection and innovative approaches for HCV+ SLKT patients are critical to further improve long-term outcomes.",
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AU - Ciancio, G.

AU - Nishida, S.

AU - Chen, L.

AU - Arosemena, L.

AU - Mattiazzi, A.

AU - Guerra, G.

AU - Kupin, W.

AU - Tekin, A.

AU - Selvaggi, G.

AU - Levi, D.

AU - Ruiz, P.

AU - Livingstone, A. S.

AU - Roth, D.

AU - Martin, P.

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