title: Simultaneous liver-kidney transplantation: a survey of US transplant centers.
abstract: Consensus recommendations have been published to help better define those patients who would benefit from simultaneous liver-kidney transplantation (SLK). We conducted a survey of transplant centers that perform SLK (n = 88, 65% response rate) to determine practice patterns in the United States. The majority of centers (73%) stated that they use dialysis duration whereas only 30% of centers use acute kidney injury duration as a criterion for determining need for SLK. Dialysis duration >4 weeks was used by 32% of centers, >6 weeks by 37% and >8 weeks by 32% of centers. Glomerular filtration rate (GFR) was estimated using the modified diet in renal disease (MDRD)-4 equation in roughly half of centers whereas the MDRD-6 equation was used by only 6%. In patients with chronic kidney disease, GFR < 40 mL/min was used by 24% of centers as a criterion for SLK transplants instead of the recommended threshold of < 30 mL/min. Regional differences in practices were also observed. This survey demonstrates significant variation in the criteria used for SLK among transplant centers, with few centers following the current published recommendations, and emphasizes the need for evidence-based guidelines and uniformity in studying renal dysfunction in liver transplant candidates.
authors: Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, CA, USA. nadim@usc.edu
authors: M K
authors: MK
authors: Nadim
authors: C L
authors: CL
authors: Davis
authors: R
authors: R
authors: Sung
authors: J A
authors: JA
authors: Kellum
authors: Y S
authors: YS
authors: Genyk
mesh_terms: D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States