Recipient survival and graft survival are not diminished by simultaneous liver-kidney transplantation: An analysis of the united network for organ sharing database

Abstract

Recipients of solitary liver and kidney transplants are living longer, and this increases their risk of long‐term complications such as recurrent hepatitis C virus (HCV) and drug‐induced nephrotoxicity. These complications may require retransplantation. Since the adoption of the Model for End‐Stage Liver Disease, the number of simultaneous liver‐kidney transplantation (SLK) procedures has increased. However, there are no standardized criteria for organ allocation to SLK candidates. The aims of this study were to retrospectively compare recipient and graft survival with liver transplantation alone (LTA), SLK, kidney after liver transplantation (KALT), and liver after kidney transplantation (LAKT) and to identify independent risk factors affecting recipient and graft survival. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database (1988‐2007) was queried for adult LTA (66,026), SLK (2327), KALT (1738), and LAKT procedures (242). After adjustments for potential confounding demographic and clinical variables, there was no difference in recipient mortality rates with LTA and SLK (P = 0.02). However, there was a 15% decreased risk of graft loss with SLK versus LTA (hazard ratio = 0.85, P < 0.001). The recipient and graft survival rates with SLK were higher than the rates with both KALT (P <0.001 and P <0.001) and LAKT (P = 0.003 and P < 0.001). The following were all identified as independent negative predictors of recipient mortality and graft loss: recipient age ≥ 65 years, male sex, black race, HCV/diabetes mellitus status, donor age ≥ 60 years, serum creatinine level ≥2.0 mg/dL, cold ischemia time > 12 hours, and warm ischemia time > 60 minutes. Although the recent increase in the number of SLK procedures performed each year has effectively decreased the number of potential donor kidneys available to patients with end‐stage renal disease (ESRD) awaiting kidney transplantation, SLK in patients with end‐stage liver disease and ESRD is justified because of the lower risk of graft loss with SLK versus LTA as well as the superior recipient and graft survival with SLK versus serial liver‐kidney transplantation. Liver Transpl, 2012. © 2012 AASLD.

Hepatitis C and its impact on renal transplantation

“…100 Data from the United Network for Organ Sharing registry have demonstrated that patient survival in com bined liver-kidney transplantation in patients with HCV infection is higher than that observed in patients who underwent renal transplantation followed by liver trans plantation, or vice versa. 101 An additional study using data from this registry showed that in recipients of renal trans plants with both HCV and HIV, the HCV infection was the first determinant of patient survival, thus suggesting that treatment of HCV infection should be mandatory. 102 Graft survival Several studies, predominantly retrospective in design, have demonstrated that patients with HCV infection experience lower graft survival than do patients who do not have HCV infection.…”

“…14,103 The rate of graft survival in combined liver-kidney transplantation is improved over separate transplanta tion procedures. 101 Patients infected with both HCV and HIV show lower graft survival as compared with renal transplant recipients infected with HIV alone. 100…”

A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes

“…The survival for CLKT, however, is superior to kidney transplant (KT) after LT or LT after KT. 8,9 The complexity of CLKT derives not only from the surgical procedure itself, but also from postoperative management. Recipients of LT are frequently coagulopathic and often require pressors to correct perioperative hypotension.…”

Utility in Treating Kidney Failure in End-Stage Liver Disease With Simultaneous Liver-Kidney Transplantation

“…We chose the study period based on availability of a full complement of donor characteristics, up to the implementation of the Kidney Allocation System (KAS). We defined SLK transplantation as deceased donor liver and kidney transplantations occurring within 2 days in the same recipient 15,16 . We aimed to establish a cohort of adult SLK recipients without prolonged pretransplant dialysis, ie, not on dialysis, or on dialysis for fewer than 90 days at the time of transplantation, since the SLK controversy is mostly concentrated in this patient population.…”