2019 FSA Posters

P003: IMMEDIATE VERSUS DELAYED KIDNEY IMPLANTATION IN COMBINED LIVER-KIDNEY TRANSPLANTATION: SINGLE CENTER, OBSERVATIONAL STUDY
Bhavna P Singh, MD, Ramona E Nicolau-Raducu, MD, PhD, Yehuda Raveh, MD, Fouad G Souki, MD; Jackson Memorial Hospital

Introduction: Patients with combined liver-kidney transplantation (LKTx) are at the risk for poorer outcomes when compared to LTx and KTx alone. Post-Transplant renal failure secondary to hypotension and pressor usage may cause worse outcomes.

Method: 54 LKTx were performed at our center between 2016-2018. All kidneys were placed on hypothermic pulsatile pump prior Tx: 23 simultaneous KTx (at the time of LTx) and 31 delayed KTx (later time as a second operation). 74% (40/54) were on renal replacement therapy (RRT) pre-transplant and continued intraoperatively in 90% (36/40) of the cases. In all patients kidney was transplanted in the right pelvis through a separate incision. Delayed kidney graft function (DGF) was defined as need of RRT in the 1st week after KTx.

Results: The median (min-max) CIT of simultaneous and delay KTx was 9.7 (7.6-14.5) and 23.2 (13.4-49.2) hours respectively (P<0.0001). The rate of DGF of 9% (2/23) in simultaneous KTx and 16% (5/31) in delayed KTx was statistically similar (P=0.4213). Dialysis dependence at 90 days was similar 4% (1/23) in simultaneous KTx versus 6% (2/31) in delayed KTx (P=0.7386). No difference in survival at 1 year was reported between simultaneous and delayed KTx of 96% (22/23) and 97% (30/31) respectively (P=0.8291).

Conclusion: Delayed KTx whenever perioperative patient conditions preclude simultaneous LKTx appear to favor patient and graft survival.

Reference:

Ciancio G et al. Favorable Outcomes with Machine Perfusion and Longer Pump Times in Kidney Transplantation: A Single-Center, Observational Study. Clinical and Translational Research 2010; 90 (8):882-890.

Ekser B et al. A novel Approach in Combined Liver and Kidney Transplantation with Long-term Outcomes. Ann Surg 2017; 265 (5):1000-1