title: Simultaneous Liver-Kidney Transplantation in Adults: A Single-center Experience Comparing Results With Isolated Liver Transplantation.
abstract: BACKGROUND
  After introduction of the Model for End-Stage Liver Disease (MELD) score in 2002, a worldwide increasing number of simultaneous liver-kidney transplantations (SLKTx) has been observed. However, organ shortage puts into question the allocation of 2 grafts to 1 recipient. This retrospective, single-center study compared SLKTx results with isolated liver transplantation (LTx).
  
  
  METHODS
  Between 1995 and 2013, 37 SLKTx were performed in adult recipients. Every SLKTx was matched by donor age (±5 years) and transplantation date with 2 LTx (n = 74). Pretransplant, intraoperative, and post-transplant variables were collected; liver graft and patient survivals were calculated.
  
  
  RESULTS
  As expected, donor age was similar in the 2 groups (median, 39.7 years), whereas serum creatinine level, glomerular filtration rate, and MELD and D-MELD (donor age*MELD) scores were significantly higher in the SLKTx group. SLKTx had longer waiting list time (P = .0034) as well as higher surgical difficulty, testified by more blood transfusions (P = .0083), increased use of classic caval reconstruction (P = .0024), and more frequent need of abdominal packing for bleeding control (P = .0003). In addition, duration of hospital stay (P < .0001), second-look surgery (P = .0082), post-transplant dialysis (P < .0001), and post-transplant infections (P = .04) were significantly greater in SLKTx group. Acute rejection episodes involving the liver were significantly less in SLKTx than in LTx (14% vs 41%; P = .0045). Liver graft and patient survival at 10 years after transplantation was similar in the 2 groups (liver graft: SLKTx, 80% vs LTx, 77% [P = .85]; patient: SLKTx, 86% vs LTx, 79% [P = .56]).
  
  
  CONCLUSIONS
  Despite being technically challenging, SLKTx provided excellent long-term results and was shown to be an effective use of liver grafts.
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy. Electronic address: giorgia.catalano@hotmail.it.
authors.forename: G
authors.initials: G
authors.lastname: Catalano
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mazza
authors.affiliation: Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Simonato
authors.affiliation: Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tognarelli
authors.affiliation: Kidney Transplant Center and Nephrology, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Biancone
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lupo
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: Liver Transplant Center and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003131:Combined Modality Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008107:Liver Diseases / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult