Impact of donation after circulatory death allografts on outcomes following simultaneous liver-kidney transplant: A single-center experience and review of the literature

Objectives: Limited data exist on outcomes after simultaneous liver-kidney transplants with extended criteria donor grafts. We compared outcomes in recipients of simultaneous liver-kidney transplants with donation after circulatory death versus donation after brain death grafts. Materials and methods: This retrospective analysis included all liver transplants performed over a 7-year period at a single center. We compared categorical variables using the chi-square test and continuous variables using the t test. We compared survival using the Kaplan-Meier method and performed a univariate analysis of predictors of outcomes using Cox regression method. Results: Over the study period, 196 patients underwent liver transplant, with 33 (16.8%) undergoing simultaneous liver-kidney transplant. In this cohort, 23 and 10 patients, respectively, received grafts from donors after brain death versus circulatory death. Both groups were comparable with respect to age, sex, hepatitis C virus status, and presence of hepatocellular carcinoma. Median (range) Model for End-Stage Liver Disease score was higher in recipients of donation after brain death grafts (37 [26-40] vs 23 [21-24]; P < .01). Liver allograft survival was comparable in donation after brain death versus donation after circulatory death recipients (P = .82) at 1 year (64.0% vs 66.7%), 3 years (57.6% vs 55.6%), and 5 years (57.6% vs 55.6%). Patient survival was also comparable (P = .89) at 1 year (70.1% vs 77.8%), 3 years (63.1% vs 55.6%), and 5 years (63.1% vs 55.6%). Graft outcomes remained similar even after adjustment for Model for End-Stage Liver Disease score at transplant (hazard ratio 0.58; 95% CI, 0.14-2.44; P = .45). Univariate analysis of predictors of patient survival after simultaneous liver- kidney transplant showed a trend toward statistical significance with recipient age and donor male sex. Conclusions: Grafts from donors after circulatory death could help safely expand the donor pool in patients undergoing simultaneous liver-kidney transplant without compromising outcomes.