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Project

Combined liver and kidney transplantation, results in UZ Leuven

Combined liver-kidney transplantation (CLKT) is increasingly performed. There is a lack of large CLKT cohorts described in literature and there is no information on the nature of postoperative complications in comparison with liver-only recipients.  
This thesis aims to: (1) describe the UZ Leuven CLKT cohort; (2) compare the post-transplant complication rate and severity of complications of CLKT recipients to liver-only recipients. This was investigated in two studies.
(1) A retrospective study including all adult CLKT patients transplanted in UZ Leuven between 01/01/1997 and 20/12/2019 was conducted. Donor and recipient demographics as well as post-transplant outcomes were summarized for the entire cohort and these were compared for four time eras (1997-2002, 2003-2008, 2009-2014, 2015-2019). (2) A retrospective study of prospectively collected morbidity & mortality (M&M) data of all adult patients receiving a CLKT or a liver-only transplantation between 01/07/2019 and 01/03/2020 was conducted. The existing “M&M tool” to collect complications after a liver-only transplantation was expanded for this purpose. In addition to descriptive analysis of complications in CLKT and liver-only recipients, the incidence and severity (Clavien-Dindo grading) of complications were compared between the two groups.  
(1) 130 CLKTs were performed in the study period; median follow-up time was five years. Recipients became older and an increase of transplantations with organs donated after circulatory death (DCD) was observed. Overall patient, liver and kidney graft survival at one, three, five, and ten years were: 92%, 85%, 83% and 67%; 89%, 83%, 81% and 61%; and 91%, 84%, 80% and 55%, respectively. Primary non function rates of liver and kidney were low. Early allograft dysfunction of the liver occurred in 20% of cases, delayed graft function of the kidney in 10%. Kidney function was good with a median estimated glomerular filtration rate at three, six, and 12 months of 58.9 ml/min/1.73m²; 58.2 ml/min/1.73m² and 51.2 ml/min/1.73m², respectively. Liver rejection occurred in 8% of patients, kidney rejection in 21%. Liver cold ischemia time (CIT) decreased in the later time eras, kidney CIT remained stable. Recipients had a significantly longer intensive care unit (ICU) stay in later time eras. (2) Nine CLKT recipients and 36 liver-only recipients were included. CLKT patients suffered from more complications compared to liver-only recipients. The proportion of severe complications and graftrelated complications were similar between groups, though CLKT recipients experienced more general and minor complications compared to liver-only recipients. ICU and hospital stay were significantly longer in the CLKT group.
UZ Leuven patient and graft survival for CLKT is good and comparable to reported outcomes. Short-term organ dysfunction is low to acceptable. These results are obtained despite increasing recipient age and use of DCD donors. In comparison to a temporary cohort of liver-only recipients, CLKT recipients experience more postoperative complications but these are not more serious and not more graft-specific complications. The CLKT population had a considerably longer ICU and hospital stay and needs to be readmitted to ICU and hospital more often than liver-only recipients. Larger datasets are needed to further examine these findings and identify potential areas of improvement.

Date:2 Sep 2019 →  30 Jun 2020
Keywords:Combined liver and kidney transplantation
Disciplines:Transplantation surgery