The individual impact of machine perfusion on liver and kidney in simultaneous liver and kidney transplantation
Recommended Citation
Oki R, Rocha I, Al-Juburi S, Rajendran L, Kerby E, Kim D, Malinzak L, Denny J, Yoshida A, Abouljoud M, Nagai S. The individual impact of machine perfusion on liver and kidney in simultaneous liver and kidney transplantation. Am J Transplant 2025; 25(1):S77.
Document Type
Conference Proceeding
Publication Date
1-1-2025
Publication Title
Am J Transplant
Abstract
Background: Liver machine perfusion (MP) has expanded the donor pool. Liver MP may expand donor selection criteria in simultaneous liver and kidney transplantation (SLK) as well. It was reported that kidney MP could reduce a risk of delayed graft function and improve kidney graft survival. MP use for both organs in SLK can potentially increase organ usage from donation after circulatory death donors (DCD) without compromising outcomes. Method: Recent practice trends and outcomes of SLK performed between 2015 and 2024 were investigated using the United Network for Organ Sharing database. Donor types and MP use for liver and/or kidney were captured and associations with outcomes were evaluated. Cox proportional hazard model was used for analyzing the factors related to 1-year liver or kidney graft failure. Result: In total, 6,956 adult SLK were performed between 2015 and 2024. SLK from DCD increased from 4.5% in 2015 to 16% in 2023. (Figure 1) The rate of donors with KDPI>85% increased from 29% in 2015 to 35% in 2024. MP use for kidney and liver increased from 21% to 51% and 0% to 17%, respectively. (Figure 1) Overall, 37.8% of kidney allografts were placed on MP (N=2632) and 3.2% of liver allografts were placed on MP (N=222). DCD was found to be an independent risk factor of 1-year liver graft failure in the no liver MP group [hazard ration (HR) 1.51, 95%CI 1.16--1.97, p<0.01], but not in the liver MP group. KDPI>85% was an independent risk factor of 1-year kidney graft failure in the no kidney MP group [HR 1.95, 95%CI1.20--3.17, p<0.01], but not in the kidney MP group. Conclusion: While DCD was a risk factor for liver graft failure in the absence of liver MP, it was not a risk factor when liver MP was used. Similarly, while KDPI>85% was associated with an increased risk of kidney graft failure without kidney MP, kidney MP might mitigate this risk. MP for both organs might contribute to expanding the donor pool for SLK without compromising post- transplant outcomes. [Formula presented] DISCLOSURES: R. Oki: None. I. Rocha: None. S. Al-Juburi: None. L. Rajendran: None. E. Kerby: None. D. Kim: None. L. Malinzak: None. J. Denny: None. A. Yoshida: None. M. Abouljoud: None. S. Nagai: None.
Volume
25
Issue
1
First Page
S77
