Tarek Alhamad1, Christin Spatz, Tadahiro Uemura, Eric Lehman, Umar Farooq. 1. 1 Renal Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO. 2 Division of Nephrology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA. 3 Division of Transplantation, Department of Surgery, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA. 4 Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA. 5 Address correspondence to: Umar Farooq, M.D., M.S., Division of Nephrology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Dr, Mail code H040, Hershey, PA 17033.
Abstract
BACKGROUND: There has been a remarkable increase in simultaneous liver and kidney transplantations (SLK). As organ demand has increased, so has the use of donation after cardiac death (DCD). However, little is known about the outcomes of DCD in SLK. METHODS: We performed a retrospective analysis using the United Network for Organ Sharing database to compare the outcomes of DCD SLK to donation after brain death (DBD) and determine the impact of donor and recipient factors on allograft and patient survival. RESULTS: Between 2002 and 2011, a total of 3,026 subjects received SLK from DBD and 98 from DCD. Kidney, liver, and patient survival from DCD donors were inferior to DBD at 1, 3, and 5 years (P=0.0056, P=0.0035, and P=0.0205, respectively). With the use of the Cox model, DCD was a significant risk factor for kidney and liver allograft failure and patient mortality. Recipient factors that were associated with worse allograft and patient outcomes included black race, diabetes, being on a ventilator, hospitalization, delayed graft function, hepatocellular carcinoma, and intensive care unit stay. Older age of the donor was also associated with worse outcomes. CONCLUSION: Despite the decreased allograft and patient survival compared with DBD, DCD SLK provides an acceptable option for SLK, with a survival probability of more than 50% at 5 years.
BACKGROUND: There has been a remarkable increase in simultaneous liver and kidney transplantations (SLK). As organ demand has increased, so has the use of donation after cardiac death (DCD). However, little is known about the outcomes of DCD in SLK. METHODS: We performed a retrospective analysis using the United Network for Organ Sharing database to compare the outcomes of DCD SLK to donation after brain death (DBD) and determine the impact of donor and recipient factors on allograft and patient survival. RESULTS: Between 2002 and 2011, a total of 3,026 subjects received SLK from DBD and 98 from DCD. Kidney, liver, and patient survival from DCD donors were inferior to DBD at 1, 3, and 5 years (P=0.0056, P=0.0035, and P=0.0205, respectively). With the use of the Cox model, DCD was a significant risk factor for kidney and liver allograft failure and patient mortality. Recipient factors that were associated with worse allograft and patient outcomes included black race, diabetes, being on a ventilator, hospitalization, delayed graft function, hepatocellular carcinoma, and intensive care unit stay. Older age of the donor was also associated with worse outcomes. CONCLUSION: Despite the decreased allograft and patient survival compared with DBD, DCD SLK provides an acceptable option for SLK, with a survival probability of more than 50% at 5 years.
Authors: Sharon R Weeks; Xun Luo; Christine E Haugen; Shane E Ottmann; Ahmet O Gurakar; Fizza F Naqvi; Saleh A Alqahtani; Benjamin Philosophe; Andrew M Cameron; Niraj M Desai; Dorry L Segev; Jacqueline M Garonzik Wang Journal: Transplantation Date: 2020-03 Impact factor: 5.385
Authors: Su-Hsin Chang; Xiaoyan Liu; Nils P Carlsson; Yikyung Park; Graham A Colditz; Jacqueline M Garonzik-Wang; William C Chapman; Jason R Wellen; Maria B Doyle; Tarek Alhamad Journal: Transplant Direct Date: 2017-06-12