Beyond the Liver: Factors Associated with Poor Kidney Graft Outcome in Simultaneous Liver-Kidney Transplant Recipients Without Prior Dialysis
Recommended Citation
Oluborode B, Malinzak L, Kim D, Denny J, Nagai S, Abouljoud M, Yoshida A. Beyond the Liver: Factors Associated with Poor Kidney Graft Outcome in Simultaneous Liver-Kidney Transplant Recipients Without Prior Dialysis. Am J Transplant 2026; 26(1).
Document Type
Conference Proceeding
Publication Date
1-1-2026
Publication Title
Am J Transplant
Abstract
Introduction: Simultaneous liver-kidney (SLK) transplantation is increasingly performed on patients with end-stage liver disease with concomitant renal dysfunction. However, concerns exist regarding the optimal allocation of limited kidney allografts, particularly in SLK recipients who do not yet require dialysis. To identify factors that may enhance the use of the Safety Net, this study aims to investigate the clinical and demographic factors associated with kidney allograft failure in non-dialysis SLK recipients Methods: We analyzed data on a national cohort of adult recipients who underwent simultaneous liver-kidney (SLK) transplantation between Jan 1, 2018, and June 30, 2023, using the Scientific Registry of Transplant Recipients database. Eligible recipients had no previous transplants and were not on dialysis pre-transplant. The primary outcome was kidney allograft failure, defined as time from transplant to graft failure. We employed a competing-risks model, utilizing the Fine-Gray sub-distribution competing-risks Hazard Model to evaluate factors associated with graft failure while taking into account the competing risk of death with a functioning graft. Results: A total of 964 adult SLK patients met the inclusion criteria. During follow-up, 125(13.0%) patients died, including 104 (10.7%) with a functioning graft, while a total of 34 (3.5%) patients had failed kidney allografts; 7(20.6%) of these underwent another kidney transplant. On multivariate analysis, increased age and MELD score were independent predictors of patient death. Specifically, the risk of death increased by 6% for each additional year of age [RR:1.06 (95% CI:1.03,1.09)], with a notable rise after 59.4yrs. Additionally, each MELD point increase resulted in a 3.1% increased risk of death [RR:1.03 (95% CI:1.01,1.06)]. In the multivariate Fine-Gray subdistribution hazard model, there was a 4.0% increased hazard of graft failure [sHR: 1.04; (95% CI: 1.01,1.06)] for each additional year of age, and each 60-minute extension in cold ischemia time (CIT) corresponded to a 5% increased hazard of graft failure [sHR: 1.05; (95% CI: 1.01, 1.10)]. Conclusion: Older SLK recipients with extended CIT are at increased risk of graft failure. Hence, an enhanced implementation of the safety net policy among this population may promote equitable and judicious organ allocation.
Volume
26
Issue
1
