title: Outcomes and native renal recovery following simultaneous liver-kidney transplantation.
abstract: With the increase in patients having impaired renal function at liver transplant due to MELD, accurate predictors of posttransplant native renal recovery are needed to select candidates for simultaneous liver-kidney transplantation (SLK). Current UNOS guidelines rely on specific clinical criteria for SLK allocation. To examine these guidelines and other variables predicting nonrecovery, we analyzed 155 SLK recipients, focusing on a subset (n = 78) that had post-SLK native GFR (nGFR) determined by radionuclide renal scans. The 77 patients not having renal scans received a higher number of extended criteria donor organs and had worse posttransplant survival. Of the 78 renal scan patients, 31 met and 47 did not meet pre-SLK UNOS criteria. The UNOS criteria were more predictive than our institutional criteria for all nGFR recovery thresholds (20-40 mL/min), although at the most conservative cut-off (nGFR ≤ 20) it had low sensitivity (55.3%), specificity (75%), PPV (67.6%) and NPV (63.8%) for predicting post-SLK nonrecovery. On multivariate analysis, the only predictor of native renal nonrecovery (nGFR ≤ 20) was abnormal pre-SLK renal imaging (OR 3.85, CI 1.22-12.5). Our data support the need to refine SLK selection utilizing more definitive biomarkers and predictors of native renal recovery than current clinical criteria.
authors: Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA. j-levitsky@northwestern.edu
authors: J
authors: J
authors: Levitsky
authors: T
authors: T
authors: Baker
authors: S N
authors: SN
authors: Ahya
authors: M L
authors: ML
authors: Levin
authors: J
authors: J
authors: Friedewald
authors: L
authors: L
authors: Gallon
authors: B
authors: B
authors: Ho
authors: A
authors: A
authors: Skaro
authors: J
authors: J
authors: Krupp
authors: E
authors: E
authors: Wang
authors: S M
authors: SM
authors: Spies
authors: D R
authors: DR
authors: Salomon
authors: M M
authors: MM
authors: Abecassis
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000473:pathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011877:Radionuclide Imaging; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome