Kidney Delayed Graft Function After Combined Liver-Kidney Transplant

Among patients with liver failure with renal dysfunction, combined liver-kidney transplantation improves patient survival. However, according to Paolo Vincenzi, MD, and colleagues, kidney delayed graft function is a common and challenging complication that has a negative impact on clinical outcomes.

The researchers conducted a retrospective study to examine the incidence, potential risk factors, and prognostic impact of development of kidney delayed graft function following combined liver-kidney transplant in a cohort of patients with recent combined transplant. Results were reported during a poster session at the American Society of Nephrology Kidney Week 2022 in a poster titled Predictors of Kidney Delayed Graft Function and Its Prognostic Impact Following Combined Liver-Kidney Transplantation.

The study cohort included 115 consecutive combined liver-kidney transplant recipients who were transplanted at the Miami Transplant Institute between January 2015 and February 2021. All transplanted kidneys received hypothermic pulsatile machine perfusion prior to transplant.

The primary outcome of interest was development of kidney delayed graft function. Secondary outcomes were the combined incidence and severity of postoperative complications; postoperative infections; biopsy-proven acute rejection; renal function at 1, 3, 6, and 12 months posttransplant; and death-censored graft and patient survival.

Kidney delayed graft function was observed in 37.4% of the cohort (n=43/115). Results of multivariable analysis revealed five independent predictors of kidney delayed graft function: (1) preoperative dialysis, P=.0003; (2) lower recipient body mass index, P=.006; (3) older donor age, P=.003; (4) utilization of donor after cardiac death donors, P=.007; and (5) longer delay of kidney transplantation after liver transplantation (P=.0003).

Median follow-up was 36.7 months posttransplant. During follow-up, there was an association between kidney delayed graft function and a significantly increased risk of developing more severe postoperative complications (P<.000001), poorer renal function (P<.000001), and worse death-censored graft (P=.00004) and patient survival (P=.0002).

In conclusion, the researchers said, “kidney delayed graft function may be responsible for remarkable negative effects on immediate and potentially longer-term clinical outcomes after combined liver-kidney transplant. Understanding the important risk factors for kidney delayed graft function development in combined liver-kidney transplant may better guide recipient and donor selection(s) and improve clinical decisions in this increasing group of transplant recipients.”

Source: Vincenzi P, Gaynor JJ, Ciancio G. Predictors of kidney delayed graft function and its prognostic impact following combined liver-kidney transplantation. FR-PO806. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando Florida.