Graft quality matters: Survival after simultaneous liver-kidney transplant according to KDPI

Colleen Jay, Jacqueline Pugh, Glenn Halff, Greg Abrahamian, Francisco Cigarroa, Ken Washburn

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Poor renal function is associated with higher mortality after liver transplantation. Our aim was to understand the impact of kidney graft quality according to the kidney donor profile index (KDPI) score on survival after simultaneous liver-kidney (SLK) transplantation. Methods: Using United Network of Organ Sharing data from 2002 to 2013 for adult deceased donor SLK recipients, we compared survival and renal graft outcomes according to KDPI. Results: Of 4207 SLK transplants, 6% were from KDPI >85% donors. KDPI >85% recipients had significantly increased mortality (HR=1.83, 95%CI=1.44-2.31) after adjusting for recipient factors. Additionally, dialysis in the first week (HR=1.4, 95%CI=1.2-1.7) and death-censored kidney graft failure at 1 year (HR=5.7, 95%CI=4.6-7.0) were associated with increased mortality after adjusting for recipient factors and liver donor risk index score. Conclusions: KDPI >85% recipients had worse patient and graft survival after SLK. Poor renal allograft outcomes including dialysis in the first week and death-censored kidney graft failure at 1 year, which occurred more frequently with KDPI >85% grafts, were associated with significantly reduced patient survival. Questions remain about the survival impact of liver vs kidney graft quality given the close relationship between donor factors contributing to both, but KDPI can still be valuable as a metric readily available at the time of organ offers for SLK candidates.

Original languageEnglish (US)
Article numbere12933
JournalClinical Transplantation
Volume31
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Tissue Donors
Transplants
Kidney
Survival
Liver
Graft Survival
Liver Transplantation
Renal Insufficiency
Mortality
Dialysis
Information Dissemination
Kidney Transplantation
Allografts

Keywords

  • clinical outcomes
  • kidney donor profile index
  • kidney transplantation
  • liver transplantation
  • survival

ASJC Scopus subject areas

  • Transplantation

Cite this

Graft quality matters : Survival after simultaneous liver-kidney transplant according to KDPI. / Jay, Colleen; Pugh, Jacqueline; Halff, Glenn; Abrahamian, Greg; Cigarroa, Francisco; Washburn, Ken.

In: Clinical Transplantation, Vol. 31, No. 5, e12933, 01.05.2017.

Research output: Contribution to journalArticle

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abstract = "Background: Poor renal function is associated with higher mortality after liver transplantation. Our aim was to understand the impact of kidney graft quality according to the kidney donor profile index (KDPI) score on survival after simultaneous liver-kidney (SLK) transplantation. Methods: Using United Network of Organ Sharing data from 2002 to 2013 for adult deceased donor SLK recipients, we compared survival and renal graft outcomes according to KDPI. Results: Of 4207 SLK transplants, 6{\%} were from KDPI >85{\%} donors. KDPI >85{\%} recipients had significantly increased mortality (HR=1.83, 95{\%}CI=1.44-2.31) after adjusting for recipient factors. Additionally, dialysis in the first week (HR=1.4, 95{\%}CI=1.2-1.7) and death-censored kidney graft failure at 1 year (HR=5.7, 95{\%}CI=4.6-7.0) were associated with increased mortality after adjusting for recipient factors and liver donor risk index score. Conclusions: KDPI >85{\%} recipients had worse patient and graft survival after SLK. Poor renal allograft outcomes including dialysis in the first week and death-censored kidney graft failure at 1 year, which occurred more frequently with KDPI >85{\%} grafts, were associated with significantly reduced patient survival. Questions remain about the survival impact of liver vs kidney graft quality given the close relationship between donor factors contributing to both, but KDPI can still be valuable as a metric readily available at the time of organ offers for SLK candidates.",
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AU - Washburn, Ken

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N2 - Background: Poor renal function is associated with higher mortality after liver transplantation. Our aim was to understand the impact of kidney graft quality according to the kidney donor profile index (KDPI) score on survival after simultaneous liver-kidney (SLK) transplantation. Methods: Using United Network of Organ Sharing data from 2002 to 2013 for adult deceased donor SLK recipients, we compared survival and renal graft outcomes according to KDPI. Results: Of 4207 SLK transplants, 6% were from KDPI >85% donors. KDPI >85% recipients had significantly increased mortality (HR=1.83, 95%CI=1.44-2.31) after adjusting for recipient factors. Additionally, dialysis in the first week (HR=1.4, 95%CI=1.2-1.7) and death-censored kidney graft failure at 1 year (HR=5.7, 95%CI=4.6-7.0) were associated with increased mortality after adjusting for recipient factors and liver donor risk index score. Conclusions: KDPI >85% recipients had worse patient and graft survival after SLK. Poor renal allograft outcomes including dialysis in the first week and death-censored kidney graft failure at 1 year, which occurred more frequently with KDPI >85% grafts, were associated with significantly reduced patient survival. Questions remain about the survival impact of liver vs kidney graft quality given the close relationship between donor factors contributing to both, but KDPI can still be valuable as a metric readily available at the time of organ offers for SLK candidates.

AB - Background: Poor renal function is associated with higher mortality after liver transplantation. Our aim was to understand the impact of kidney graft quality according to the kidney donor profile index (KDPI) score on survival after simultaneous liver-kidney (SLK) transplantation. Methods: Using United Network of Organ Sharing data from 2002 to 2013 for adult deceased donor SLK recipients, we compared survival and renal graft outcomes according to KDPI. Results: Of 4207 SLK transplants, 6% were from KDPI >85% donors. KDPI >85% recipients had significantly increased mortality (HR=1.83, 95%CI=1.44-2.31) after adjusting for recipient factors. Additionally, dialysis in the first week (HR=1.4, 95%CI=1.2-1.7) and death-censored kidney graft failure at 1 year (HR=5.7, 95%CI=4.6-7.0) were associated with increased mortality after adjusting for recipient factors and liver donor risk index score. Conclusions: KDPI >85% recipients had worse patient and graft survival after SLK. Poor renal allograft outcomes including dialysis in the first week and death-censored kidney graft failure at 1 year, which occurred more frequently with KDPI >85% grafts, were associated with significantly reduced patient survival. Questions remain about the survival impact of liver vs kidney graft quality given the close relationship between donor factors contributing to both, but KDPI can still be valuable as a metric readily available at the time of organ offers for SLK candidates.

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