The Role of Machine Perfusion in Expanding Donor Utilization for Simultaneous Liver and Kidney Transplantation

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: The use of MP(Machine perfusion) for both the kidney and liver has the potential to increase organ utilization in simultaneous liver-kidney transplantation (SLKT). The purpose of this study was to examine: 1) the trends over time in donor types and the use of MP for kidney and liver transplantation, and 2) whether medically complex donors pose a risk factor for 1-year graft survival between the use of MP and without MP for each organ in SLKT. Methods: We analyzed SLKT performed between 2015 and 2024 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. Results: IIn total, 6,956 adult SLKT were performed during the study period. SLK from circulatory death donors (DCD) increased from 4.5% in 2015 to 16% in 2023. (Figure 1)The median Kidney Donor Profile Index (KDPI) has shown an increasing trend from 23% in 2015 to 28% in 2023. 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). KDPI>85% was an independent risk factor of 1-year kidney graft failure in the no kidney MP group [HR 2.03, 95%CI 1.20-3.44, p=0.009], but not in the kidney MP group. (Table1) DCD was found to be an independent risk factor of 1-year liver graft failure in the no liver MP group [HR 1.56, 95%CI 1.19-2.03, p=0.001], but not in the liver MP group. (Table2) Conclusions: Although DCD was a risk factor for liver graft failure without MP for liver, it ceased to be a risk factor when MP was applied. Likewise, although KDPI >85% was linked to a higher risk of kidney graft failure without MP for kidney, MP for kidney might help reduce this risk. MP might also enable the use of lower-quality organs, thereby further expanding the donor pool in SLKT. [Formula presented] [Formula presented] [Formula presented] CITATION INFORMATION: Oki R., Rocha I., Al-Juburi S., Rajendran L., Kerby E., Kim D., Yoshida A., Abouljoud M., Nagai S. The Role of Machine Perfusion in Expanding Donor Utilization for Simultaneous Liver and Kidney Transplantation AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: R. Oki: None.

Volume

25

Issue

8

First Page

S273

Last Page

S274

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