Current status of combined liver-kidney transplantation

Ekser, Burçin; Contreras, Alan G.; Andraus, Wellington; Taner, Timuçin

doi:10.1016/j.ijsu.2020.02.008

Cited by 21 publications

(27 citation statements)

References 34 publications

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“…Although DGF of transplanted kidneys was much lower compared with literature (overall 4% in our series), 23 , 24 it was 25% in elderly (≥70 y) patients and significantly higher compared with younger recipients ( P = 0.017). Intensive care unit stay and overall hospital stay were significantly longer in elderly recipients compared with younger recipients (Table 2 ).…”

Section: Resultscontrasting

confidence: 71%

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Ekser

Goggins

Fridell

et al. 2020

Transplantation Direct

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Background. Elderly recipients (≥70 y) account for 2.6% of all liver transplants (LTs) in the United States and have similar outcomes as younger recipients. Although the rate of elderly recipients in combined liver-kidney transplant (CLKT) is similar, limited data are available on how elderly recipients perform after CLKT. Methods. We have previously shown excellent outcomes in CLKT using delayed kidney transplant (Indiana) Approach (mean kidney cold ischemia time = 53 ± 14 h). Between 2007 and 2018, 98 CLKTs were performed using the Indiana Approach at Indiana University (IU) and the data were retrospectively analyzed. Recipients were subgrouped based on their age: 18–45 (n = 16), 46–59 (n = 34), 60–69 (n = 40), and ≥70 years (n = 8). Results. Overall, more elderly patients received LT at IU (5.2%) when compared nationally (2.6%). The rate of elderly recipients in CLKT at IU was 8.2% (versus 2% Scientific Registry of Transplant Recipient). Recipient and donor characteristics were comparable between all age groups except recipient age and duration of dialysis. Patient survival at 1 and 3 years was similar among younger age groups, whereas patient survival was significantly lower in elderly recipients at 1 (60%) and 3 years (40%) ( P = 0.0077). Control analyses (replicating Scientific Registry of Transplant Recipient’s survival stratification: 18–45, 46–64, ≥65 y) showed similar patient survival in all age groups. Conclusions. Although LT can be safely performed in elderly recipients, extreme caution is needed in CLKT due to the magnitude of operation.

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Section: Resultscontrasting

confidence: 71%

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Ekser

Goggins

Fridell

et al. 2020

Transplantation Direct

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“…Of course, minimizing the CIT time is still a key point for reducing the risk of DGF or other cold ischemia complications, 5,7 but there are several clinical circumstances in which such strategy may not be applicable. 12,13,[21][22][23] Distant organ procurement, delay in pathological examination response on scoring of ECD kidney grafts, combined liver-kidney or heart-kidney transplantation, or necessity of pre-KT dialysis, are all examples that belong to the routine clinical practice. The present study provided some new encouraging insight, but we hope that it will also trigger further analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, the present findings as well as the pragmatic analysis of previously reported results from large clinical series or randomized trials do actually support the safety of using HMP to extend the CIT time, without any significant additional risk. Of course, minimizing the CIT time is still a key point for reducing the risk of DGF or other cold ischemia complications, 5,7 but there are several clinical circumstances in which such strategy may not be applicable 12,13,21‐23 . Distant organ procurement, delay in pathological examination response on scoring of ECD kidney grafts, combined liver‐kidney or heart‐kidney transplantation, or necessity of pre‐KT dialysis, are all examples that belong to the routine clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

et al. 2021

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In deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P < .001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P = .02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P < .01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter. K E Y W O R D Scold ischemia time, delayed graft function, hypothermic machine perfusion, kidney transplant morbidity, kidney transplantation How to cite this article: Adani GL, Pravisani R, Tulissi P, et al. Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function.

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“…With improving medical management of chronic liver failure, and the shortage of transplantable liver grafts, many patients present late stage for LT with high MELD (Model for End-stage Liver Disease) score and chronic kidney disease. In fact, in the last decade the number of patients requiring combined liver-kidney transplant (CLKT) has been steadily increasing, now making 10% of all LTs in the United States [17]. Another staged surgical procedure 'delayed kidney transplantation in CLKT -Indiana Approach' and other recent developments in CLKTs have been comprehensively reviewed [17].…”

mentioning

confidence: 99%

“…In fact, in the last decade the number of patients requiring combined liver-kidney transplant (CLKT) has been steadily increasing, now making 10% of all LTs in the United States [17]. Another staged surgical procedure 'delayed kidney transplantation in CLKT -Indiana Approach' and other recent developments in CLKTs have been comprehensively reviewed [17].…”

mentioning

confidence: 99%

Liver transplantation and hepatobiliary surgery in 2020

Ekser

Halazun

Petrowsky³

et al. 2020

International Journal of Surgery

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Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Current status of combined liver-kidney transplantation

Cited by 21 publications

References 34 publications

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Impact of Recipient Age in Combined Liver-Kidney Transplantation: Caution Is Needed for Patients ≥70 Years

Hypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function

Liver transplantation and hepatobiliary surgery in 2020

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