Need for Pretransplant Midodrine Does Not Negatively Impact Simultaneous Liver-kidney Transplant Outcomes

Area of Science:

• Transplant Surgery
• Nephrology
• Hepatology

Background:

• Midodrine is frequently required pretransplant for hemodynamic stability in simultaneous liver-kidney transplant candidates.
• Prior studies indicate increased posttransplant risks for kidney-only transplant recipients on midodrine.
• The effect of pretransplant midodrine on simultaneous liver-kidney transplant outcomes remains unclear.

Purpose of the Study:

• To evaluate the impact of pretransplant midodrine use on outcomes in simultaneous liver-kidney transplant recipients.
• To determine if midodrine necessity influences posttransplant graft function, failure, or survival.

Main Methods:

• Retrospective analysis of adult simultaneous liver-kidney transplant recipients (N=64) from February 2002 to June 2019.
• Comparison of outcomes between patients on midodrine (n=17) and those not on midodrine (n=43).
• Analysis included assessment of delayed graft function, estimated glomerular filtration rate (eGFR), graft failure, and survival.

Main Results:

• Despite higher MELD-Na scores and older age in the midodrine group, no significant differences were observed in delayed renal allograft function.
• Posttransplant eGFR at discharge and 1-year follow-up showed no significant variation between groups.
• Graft failure and patient survival rates were comparable between the midodrine and non-midodrine groups.

Conclusions:

• Pretransplant midodrine use is not associated with adverse outcomes in simultaneous liver-kidney transplant recipients.
• The need for midodrine should not preclude patients from undergoing simultaneous liver-kidney transplantation.
• This study supports the continued use of midodrine for hemodynamic management in select SLK transplant candidates.