Transplantation direct · 2026
The Impact of Normothermic Machine Liver Perfusion on Early Renal Outcomes After Simultaneous Liver-kidney Transplantation: A Propensity Score-Matched Analysis.
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Nadeem Muhammad A, Wehrle Chase J, Satish Sangeeta, Siddiqui Hafiz Umair, Verma Sapana, Sanha Valberto, Ali Khaled, Khalil Mazhar, Pita Alejandro, Esfeh Jamak Modaresi, Kwon David C H, Aucejo Federico, Kim Jaekeun, Pinna Antonio D, Eltemamy Mohamed, Miller Charles, Fujiki Masato, Fairchild Robert L, Fatica Richard A, Hashimoto Koji, Wee Alvin, Schlegel Andrea, Cleveland Clinic Liver Perfusion Group
Аннотация
BACKGROUND: No study has assessed the effect of end-ischemic normothermic machine perfusion (NMP) on renal function in simultaneous liver-kidney (SLK) transplantation. We hypothesized that by mitigating liver ischemia/reperfusion injury, NMP exerts a renoprotective effect on kidney allografts. This study compares renal outcomes in SLK transplant recipients receiving NMP versus static cold storage (SCS) livers.
METHODS: We analyzed deceased-donor SLK transplant recipients (January 2019-July 2024) with at least 6 mo follow-up (n = 85). Primary outcomes included delayed graft function (DGF) and functional-DGF (f-DGF; failure of serum creatinine to decrease 10% daily for 3 d in the first week). Liver Core Outcome Sets were reported. NMP recipients (n = 17) were propensity score-matched 1:2 to SCS controls (n = 34). Kidneys underwent hypothermic machine perfusion in both groups.
RESULTS: Cohorts were well matched, although NMP had more donation after circulatory death donors (P = 0.006). f-DGF was significantly lower in NMP versus SCS (35% versus 68%, P = 0.025); this persisted in the hepatorenal syndrome subcohort (27% versus 65%, P = 0.03). Post-reperfusion syndrome was lower in NMP (P = 0.041). NMP demonstrated superior renal function: lower peak creatinine (2.58 versus 3.03 mg/dL, P = 0.031), higher lowest postoperative estimated glomerular filtration rate (25 versus 19 mL/min/1.73 m2, P = 0.021), and reduced 6-mo dialysis requirement (6% versus 32%, P = 0.036).
CONCLUSIONS: In this cohort, NMP was associated with improved early renal recovery in SLK transplant recipients, characterized by lower rates of f-DGF and higher estimated glomerular filtration rate. These findings suggest that mitigating liver ischemia via NMP may provide secondary benefits to the simultaneous kidney allograft.
METHODS: We analyzed deceased-donor SLK transplant recipients (January 2019-July 2024) with at least 6 mo follow-up (n = 85). Primary outcomes included delayed graft function (DGF) and functional-DGF (f-DGF; failure of serum creatinine to decrease 10% daily for 3 d in the first week). Liver Core Outcome Sets were reported. NMP recipients (n = 17) were propensity score-matched 1:2 to SCS controls (n = 34). Kidneys underwent hypothermic machine perfusion in both groups.
RESULTS: Cohorts were well matched, although NMP had more donation after circulatory death donors (P = 0.006). f-DGF was significantly lower in NMP versus SCS (35% versus 68%, P = 0.025); this persisted in the hepatorenal syndrome subcohort (27% versus 65%, P = 0.03). Post-reperfusion syndrome was lower in NMP (P = 0.041). NMP demonstrated superior renal function: lower peak creatinine (2.58 versus 3.03 mg/dL, P = 0.031), higher lowest postoperative estimated glomerular filtration rate (25 versus 19 mL/min/1.73 m2, P = 0.021), and reduced 6-mo dialysis requirement (6% versus 32%, P = 0.036).
CONCLUSIONS: In this cohort, NMP was associated with improved early renal recovery in SLK transplant recipients, characterized by lower rates of f-DGF and higher estimated glomerular filtration rate. These findings suggest that mitigating liver ischemia via NMP may provide secondary benefits to the simultaneous kidney allograft.