Outcomes of simultaneous liver/kidney transplants are equivalent to kidney transplant alone: a preliminary report.
BACKGROUND
With adoption of Model for End-Stage Liver Disease, the number of simultaneous liver-kidney transplants (SLK) has greatly increased. A recent registry study questioned the equity of allocating kidney transplants (KTx) simultaneously with liver transplantation due to poor outcomes (Locke et al., Transplantation 2008; 85: 935).


METHODS
To investigate outcome of KTx in SLK, all SLK (n=36) performed at our center from January 2000 to December 2007 were reviewed and KTx outcomes compared with those of kidney transplant alone (KTA) performed during that period (n=1283). We also reviewed whether pretransplant panel reactive antibody and donor-specific antibody affected KTx outcome in SLK.


RESULTS
One- and 3-year KTx and patient survival were not different between KTA and SLK regardless of sensitization level. There were 348 (27%) KTx failures in KTA vs. 6 (17%) in SLK (NS). Overall freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR) in SLK was 93 and 96% at 3 years, compared with 72 and 78% in KTA (P=0.0105 and P=0.0744, respectively). Sensitized KTx recipients had more ACR and AMR (32 and 38%) at 3 years compared with nonsensitized recipients (28 and 20%) (P=0.23 and 0.0001, respectively). No differences in ACR and AMR were observed when SLK was divided and level of sensitization compared (P=0.17 and 0.65, respectively).


CONCLUSIONS
SLK is a life-saving procedure with excellent patient and graft survival. AMR incidence in the KTx appears reduced in SLK compared with KTA regardless of level of preoperative panel reactive antibody. A high level of donor-specific antibody should not preclude simultaneous transplantation when clinically indicated.
Hanish
Steven I
SI
Division of Liver Transplantation, The Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, USA.
Samaniego
Milagros
M
Mezrich
Joshua D
JD
Foley
David P
DP
Leverson
Glen E
GE
Lorentzen
David F
DF
Sollinger
Hans W
HW
Pirsch
John D
JD
D'Alessandro
Anthony M
AM
Fernandez
Luis A
LA
D000208:Acute Disease; D000328:Adult; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000276:immunology / Q000401:mortality / Q000502:physiology; D016896:Treatment Outcome