Combined liver-dual kidney transplant: Role in expanded donors.
Kidney injury is a common clinical feature among liver transplantation (LT) candidates that heavily affects prognosis and complicates the surgical decision-making process. Up to 20% of patients undergoing LT demonstrate some degree of renal impairment, and 2% will benefit from a combined liver-kidney transplantation (LKT). We present a case-control study of all patients who underwent LKT and combined liver-dual kidney transplantation (LDKT) from November 2013 to March 2016. For the selection of LDKT candidates, a histological-based algorithm was applied: when evaluating extended criteria donors (ECDs), with any Remuzzi score between 4 and 7, we would consider performing a LDKT instead of a simple LKT. Study groups were similar for recipient variables. In the LDKT group, donor age, donor risk index, and donor body mass index were found to be significantly higher. Biopsies obtained from all pairs of kidney grafts in the LDKT group demonstrated the following Remuzzi scores: 4+4, 4+4, 7+1, 4+5. Despite longer operative times for the LDKT procedure, no differences were observed regarding the main investigated outcome parameters. Overall survival was 100% (LDKT) and 91% (LKT, P > 0.99). This is a preliminary experience which might indicate that LDKT is a safe, feasible, and resource-effective technique. The evaluation of a larger cohort, as well as the experience from other centers, would be needed to clearly identify its role in the ECD era. Liver Transplantation 23:28-34 2017 AASLD.
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Marco
M
Di Laudo
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Matteo
M
Ravaioli
Department of Nephrology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Gaetano
G
La Manna
Department of Nephrology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Giorgia
G
Comai
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Matteo
M
Cescon
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Massimo
M
Del Gaudio
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Chiara
C
Zanfi
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Alessandro
A
Cucchetti
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Giorgio
G
Ercolani
Department of General Surgery and Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Antonio Daniele
AD
Pinna
D000328:Adult; D000367:Age Factors; D000368:Aged; D064591:Allografts / Q000473:pathology; D001706:Biopsy; D015992:Body Mass Index; D016022:Case-Control Studies; D046148:Donor Selection / Q000379:methods*; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D008099:Liver / Q000473:pathology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult