title: Evolving frequency and outcomes of simultaneous liver kidney transplants based on liver disease etiology.
abstract: BACKGROUND
  The frequency of simultaneous liver kidney (SLK) transplantation is increasing. Data are scanty on outcomes of SLK transplants for liver disease etiology.
  
  
  METHODS
  Outcomes for liver and kidney grafts and patients survival at 5 years were compared for liver disease etiology among adults receiving SLK during 2002 and 2011 in the United States. Cox regression analysis models were built to determine the independent impact of liver disease etiology on outcomes.
  
  
  RESULTS
  A total of 2,606 patients (mean age 53 years, 69% males, 55% Caucasians) received SLK for primary biliary cirrhosis (PBC, n=76), primary sclerosing cholangitis (n=81), hepatitis C virus (HCV) (n=945), alcoholic liver disease (n=495), alcohol and HCV (n=152), cryptogenic cirrhosis (CC, n=289), nonalcoholic steatohepatitis (NASH) (n=221), hepatitis B virus (HBV) (n=98), and hepatocellular carcinoma (HCC) (n=249). HCV and NASH+CC contributed to about 44% and 9%, respectively, of all SLK transplants in 2002. Corresponding figures in 2011 were 34% and 22%, respectively. Compared to PBC, 5-year outcomes were worse for NASH, HCV, and HCC for liver graft (72%, 66%, and 72% vs. 82%; hazard ratio, HR: 2.5-3.1), kidney graft (71%, 65%, and 71% vs. 80%; HR: 2.3-2.8), and patient survival (74%, 69%, and 69% vs. 82%; HR: 2.4-2.7). Follow-up renal function assessed at 1, 3, and 5 years showed poor renal function among patients receiving SLK for HCV, NASH, CC, and HBV.
  
  
  CONCLUSIONS
  Frequency of SLK transplants is increasing among NASH patients. Overall graft and patient outcomes are good. However, SLK for NASH, HCV, and HCC do worse. Strategies are needed to improve outcomes for SLK in HCV and NASH patients.
authors.affiliation: 1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 2 Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL. 3 Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX. 4 Department of Biostatistics, University of Texas Medical Branch, Galveston, TX. 5 Address correspondence to: Ashwani K. Singal, M.D., M.S., Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0012.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.forename: Habeeb
authors.initials: H
authors.lastname: Salameh
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States