title: The outcomes of simultaneous liver and kidney transplantation using donation after cardiac death organs.
abstract: BACKGROUND
  There has been a remarkable increase in simultaneous liver and kidney transplantations (SLK). As organ demand has increased, so has the use of donation after cardiac death (DCD). However, little is known about the outcomes of DCD in SLK.
  
  
  METHODS
  We performed a retrospective analysis using the United Network for Organ Sharing database to compare the outcomes of DCD SLK to donation after brain death (DBD) and determine the impact of donor and recipient factors on allograft and patient survival.
  
  
  RESULTS
  Between 2002 and 2011, a total of 3,026 subjects received SLK from DBD and 98 from DCD. Kidney, liver, and patient survival from DCD donors were inferior to DBD at 1, 3, and 5 years (P=0.0056, P=0.0035, and P=0.0205, respectively). With the use of the Cox model, DCD was a significant risk factor for kidney and liver allograft failure and patient mortality. Recipient factors that were associated with worse allograft and patient outcomes included black race, diabetes, being on a ventilator, hospitalization, delayed graft function, hepatocellular carcinoma, and intensive care unit stay. Older age of the donor was also associated with worse outcomes.
  
  
  CONCLUSIONS
  Despite the decreased allograft and patient survival compared with DBD, DCD SLK provides an acceptable option for SLK, with a survival probability of more than 50% at 5 years.
authors.affiliation: 1 Renal Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO. 2 Division of Nephrology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA. 3 Division of Transplantation, Department of Surgery, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA. 4 Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA. 5 Address correspondence to: Umar Farooq, M.D., M.S., Division of Nephrology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Dr, Mail code H040, Hershey, PA 17033.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad
authors.forename: Christin
authors.initials: C
authors.lastname: Spatz
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Uemura
authors.forename: Eric
authors.initials: E
authors.lastname: Lehman
authors.forename: Umar
authors.initials: U
authors.lastname: Farooq
mesh_terms: D000328:Adult; D001926:Brain Death; D003643:Death; D051799:Delayed Graft Function; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods*; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome