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Simultaneous liver-kidney transplantation from donation after cardiac death donors: an updated perspective

Rafael Nunez-Nateras1, Kunam S Reddy1, Bashar A Aqel2

  • 1Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|July 13, 2020
PubMed

Insights

Simultaneous liver-kidney transplants using donation after cardiac death (DCD) donors show comparable survival rates to donation after brain death (DBD) donors. DCD SLK recipients experienced similar graft function but a higher incidence of biliary complications.

Area of Science:

  • Transplant Surgery
  • Organ Transplantation
  • Nephrology
  • Hepatology

Background:

  • Donation after cardiac death (DCD) liver and kidney transplant outcomes are improving.
  • Simultaneous liver-kidney transplant (SLK) experience with DCD donors is limited.
  • DCD donors represent an expanding donor pool for transplantation.

Purpose of the Study:

  • To compare outcomes of simultaneous liver-kidney transplants (SLK) using DCD donors versus donation after brain death (DBD) donors.
  • To evaluate graft survival, patient survival, and complication rates in DCD SLK recipients.
  • To assess long-term kidney function and fibrosis progression in DCD SLK recipients.

Main Methods:

  • Retrospective review of a cohort of DCD SLK (n=30) and DBD SLK (n=131) recipients from 2010-2018.
  • Comparison of pre-transplant characteristics, including Model for End-Stage Liver Disease (MELD) score.
  • Analysis of 1-year outcomes: graft and patient survival, delayed graft function (DGF), estimated glomerular filtration rate (eGFR), and protocol kidney biopsy findings.
  • Assessment of complication rates, particularly biliary complications and ischemic cholangiopathy.

Main Results:

  • DCD SLK recipients had a lower MELD score (23 vs 29, P=.01).
  • Kidney delayed graft function (DGF) rates were similar (P=.11), but duration was longer in DCD SLK (20 vs 4 days, P=.01).
  • One-year liver allograft (93.3% vs 93.1%), kidney allograft (93.3% vs 93.1%), and patient survival (96.7% vs 95.4%) were similar between DCD and DBD SLK groups.
  • No significant differences in 1-year eGFR (P=.75) or kidney fibrosis progression (P=.67) were observed.
  • A higher incidence of biliary complications, primarily ischemic cholangiopathy, occurred in the DCD SLK group (10.0% vs 0.0%, P=.03).

Conclusions:

  • Simultaneous liver-kidney transplantation using DCD donors can achieve outcomes comparable to those using DBD donors.
  • Careful donor and recipient selection is crucial for successful DCD SLK.
  • While DCD SLK shows promise, increased vigilance for biliary complications is warranted, though most are manageable endoscopically.

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