Lack of Benefit and Potential Harm of Induction Therapy in Simultaneous Liver‐Kidney Transplants

Ekser, Burçin; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Sharfuddin, Asif; Taber, Tim E.; Lacerda, Marco A.; Ghabril, Marwan; Powelson, John A.; Goggins, William C.

doi:10.1002/lt.25428

Cited by 3 publications

(4 citation statements)

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“…Details of the immunosuppressive regimen and prophylaxis protocol in CLKT recipients have been reported previously. 9 , 19 , 21 Briefly, induction therapy included rabbit antithymocyte globulin (rATG) (2 mg/kg for 3 doses), and anti-CD20 monoclonal antibody (Rituximab, single dose 1.5 mg/m 2 , maximum 300 mg), only in case of increased immunologic risk. rATG was administered before the implantation of the kidney allograft on postoperative day 1 or 2, depending on recipient’s hemodynamic stability.…”

Section: Methodsmentioning

confidence: 99%

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: Methodsmentioning

confidence: 99%

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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“…22,23 Notably, regarding the use of anti-depleting agents in the induction phase, AbdulRahim et al 22 revealed that smLKT patients treated with antithymocyte globulin exhibited a higher mortality rate (p = 0.002). On contrary, Ekser et al 24 reported the tailored management on the use of r-ATG induction would show better outcomes of smLKT.…”

Section: Immunological Aspect and Immunosuppression Regimenmentioning

confidence: 95%

“…35 There Although all ARPKD cases display some degree of CHF, the severity of the disease in the liver and kidneys are independent of each other. [22][23][24] Notably, approximately 40% of patients exhibit severe involvement of both the kidney and liver, making them potential candidates for CLKT. 37 The timing for LT in ARPKD varies significantly, largely depending on phenotype severity like portal hypertension and cholangitis-related sepsis.…”

Section: Arpkd With Chfmentioning

confidence: 99%

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Combined liver‐kidney transplantation in pediatric patients

Yi,

Kim,

Hong

et al. 2023

Pediatric Transplantation

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Combined liver‐kidney transplantation (CLKT) is a surgical procedure that involves transplanting both liver and kidney organs. There are two types of CLKT: simultaneous liver‐kidney transplantation (smLKT) and sequential LKT (sqLKT). CLKT accounts for a small percentage of liver transplantations (LTs), particularly in pediatric cases. Nevertheless, the procedure has demonstrated excellent outcomes, with high survival rates and lower rejection rates. The main indications for CLKT in pediatric patients differ somewhat from that in adults, in which end‐stage kidney disease after LT is the major indication. In children, congenital diseases are common reason for performing CLKT; the examples of such diseases include autosomal recessive polycystic kidney disease with congenital hepatic fibrosis which equally affects both organs, and primary hyperoxaluria type 1, a primary liver disease leading kidney failure. The decision between smLKT or sqLKT depends on the dominant organ failure, the specific pathophysiology, and available organ sources. However, there remain significant surgical and societal challenges surrounding CLKT. Innovations in pharmacology and genetic engineering have decreased the necessity for CLKT in early‐diagnosed cases without portal hypertension or kidney replacement therapy. Nonetheless, these advancements are not universally accessible. Therefore, decision‐making algorithms should be crafted, considering region‐specific organ allocation systems and prevailing medical environments.

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