title: Inferior long-term outcomes of liver-kidney transplantation using donation after cardiac death donors: single-center and organ procurement and transplantation network analyses.
abstract: Limited data are available for outcomes of simultaneous liver-kidney (SLK) transplantation using donation after cardiac death (DCD) donors. The outcomes of 12 DCD-SLK transplants and 54 SLK transplants using donation after brain death (DBD) donors were retrospectively compared. The baseline demographics were similar for the DCD-SLK and DBD-SLK groups except for the higher liver donor risk index for the DCD-SLK group (1.8 ± 0.4 versus 1.3 ± 0.4, P = 0.001). The rates of surgical complications and graft rejections within 1 year were comparable for the DCD-SLK and DBD-SLK groups. Delayed renal graft function was twice as common in the DCD-SLK group. At 1 year, the serum creatinine levels and the iothalamate glomerular filtration rates were similar for the groups. The patient, liver graft, and kidney graft survival rates at 1 year were comparable for the groups (83.3%, 75.0%, and 82.5% for the DCD-SLK group and 92.4%, 92.4%, and 92.6% for the DBD-SLK group, P = 0.3 for all). The DCD-SLK group had worse patient, liver graft, and kidney graft survival at 3 years (62.5%, 62.5%, and 58.9% versus 90.5%, 90.5%, and 90.6%, P = 0.03 for all) and at 5 years (62.5%, 62.5%, and 58.9% versus 87.4%, 87.4%, and 87.7%, P < 0.05 for all). An analysis of the Organ Procurement and Transplantation Network database showed inferior 1- and 5-year patient and graft survival rates for DCD-SLK patients versus DBD-SLK patients. In conclusion, despite comparable rates of surgical and medical complications and comparable kidney function at 1 year, DCD-SLK transplantation was associated with inferior long-term survival in comparison with DBD-SLK transplantation.
authors.affiliation: Department of Transplantation, Mayo Clinic, Jacksonville, FL.
authors.forename: Hani M
authors.initials: HM
authors.lastname: Wadei
authors.forename: Ilynn G
authors.initials: IG
authors.lastname: Bulatao
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gonwa
authors.forename: Martin L
authors.initials: ML
authors.lastname: Mai
authors.forename: Mary
authors.initials: M
authors.lastname: Prendergast
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.forename: Barry G
authors.initials: BG
authors.lastname: Rosser
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D016208:Databases, Factual; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D005431:Florida; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome