title: Nonalcoholic Steatohepatitis is the Most Rapidly Growing Indication for Simultaneous Liver Kidney Transplantation in the United States.
abstract: BACKGROUND
  Frequency of liver transplantation (LT) is increasing in nonalcoholic steatohepatitis (NASH) with good post-transplant outcomes. Similar data on simultaneous liver kidney (SLK) transplants are limited.
  
  
  METHODS
  United Network for Organ Sharing database (2002-2011) queried for deceased donor first LT for primary biliary cirrhosis, primary sclerosing cholangitis, or alcoholic cirrhosis (group I), NASH, and cryptogenic cirrhosis with body mass index greater than 30 (group II), and hepatitis C virus with and without alcohol, hepatitis B virus, and hepatocellular carcinoma (group III).
  
  
  RESULTS
  Of 38 533 LT (9495, 3665, and 25 383 in groups I-III, respectively), about 5.6% (N = 2162) received SLK with 584 (6.2%), 320 (8.7%), and 1258 (5%) in groups I-III, respectively. The SLK performed for group II increased from 6.3% in 2002 to 2003 to 19.2% in 2010 to 2011. Similar trends remained unchanged in group I (26.1 to 26.6%) and decreased in group III (67.6 to 54.5%). Five-year outcomes were similar comparing group II versus group I for liver graft (78 vs 74%, P = 0.14) and patient survival (81 vs 76%, P = 0.07). In contrast, kidney graft outcome was worse for group II (70 vs 79%, P = 0.002). Risk of kidney graft loss was over 1.5-fold higher among group II SLK recipients compared to group I after controlling for recipient characteristics. Estimated glomerular filtration rate remained lower in group II compared with group I at various time points after SLK transplantation.
  
  
  CONCLUSIONS
  The NASH is the most rapidly growing indication for SLK transplantation with poor renal outcomes. Studies are needed to examine mechanisms of these findings and develop strategies to improve renal outcomes in SLK recipients for NASH.
authors.affiliation: 1Department of Gastroenterology and Hepatology, University of Alabama, Birmingham, AL. 2 Department of Internal Medicine, University of Alabama, Montgomery, AL. 3 Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 4 Department of Biostatistics, University of Texas Medical Branch, Galveston, AL.
authors.forename: Ashwani Kumar
authors.initials: AK
authors.lastname: Singal
authors.forename: Mohsen
authors.initials: M
authors.lastname: Hasanin
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kaif
authors.forename: Russell
authors.initials: R
authors.lastname: Wiesner
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology