title: Outcomes of simultaneous liver/kidney transplants are equivalent to kidney transplant alone: a preliminary report.
abstract: 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.
authors.affiliation: Division of Liver Transplantation, The Emory Transplant Center, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Steven I
authors.initials: SI
authors.lastname: Hanish
authors.forename: Milagros
authors.initials: M
authors.lastname: Samaniego
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Mezrich
authors.forename: David P
authors.initials: DP
authors.lastname: Foley
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: David F
authors.initials: DF
authors.lastname: Lorentzen
authors.forename: Hans W
authors.initials: HW
authors.lastname: Sollinger
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
mesh_terms: 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