title: Long-Term Outcomes of Simultaneous Liver-Kidney Transplant Patients with Hepatitis B Compared to with Liver Transplant Alone.
abstract: BACKGROUND
  The number and survival rate of simultaneous liver-kidney transplant (SLKT) recipients have increased dramatically since 2002. However, the long-term effectiveness of SLKT in patients with hepatitis B is unknown.
  
  
  METHODS
  Forty-six patients who visited the Organ Transplant Center of the Shanghai First People's Hospital between January 2001 and May 2005 had hepatitis B virus infection and renal failure (any degree), and underwent organ transplantation: 21 patients underwent SLKT and 25 patients underwent liver transplant (LT) alone.
  
  
  RESULTS
  The 1-, 3-, and 5-year survival rates of SLKT recipients were 90.5%, 81.0%, and 81.0%, respectively. Incidence of acute hepatic allograft rejection between SLKT recipients and LT recipients (33% vs. 16%) did not reach significance (P=0.170). Despite higher infection rate, more prevalent hepatitis B relapse, and longer stay in the intensive care unit, SLKT recipients experienced significantly higher 1-year survival rate (90.5%) compared with LT recipients (60%, P=0.019). Multivariate regression analysis revealed that postoperative renal failure (odds ratio (OR)=48, P=0.003) and Risk/Injury/Failure/Loss/End-stage (RIFLE) stage (OR=8, P=0.012) were independent risk factors for postoperative death after LT.
  
  
  CONCLUSIONS
  SLKT in patients with hepatitis B had higher early-stage infection rate, but had a higher long-term survival rate compared with the LT group. Although the incidence of postoperative hepatitis B relapse in SLKT recipients was higher, timely and reasonable treatment can ensure long-term survival of patients. Worsening RIFLE stage of recipients can predict high mortality when only given LT. SLKT might be a better choice for RIFLE stage 2 or 3 patients than LT alone.
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China (mainland).
authors.forename: Ming-Qi
authors.initials: MQ
authors.lastname: Fan
authors.affiliation: Department of Urology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland).
authors.forename: Tong-Yi
authors.initials: TY
authors.lastname: Men
authors.affiliation: Department of Urology, Hospital of Hebei Provincial Armed Police Force, Shijiazhuang, Hebei, China (mainland).
authors.forename: Yun-Peng
authors.initials: YP
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).
authors.forename: Tong-Hai
authors.initials: TH
authors.lastname: Xing
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).
authors.forename: Jun-Wei
authors.initials: JW
authors.lastname: Fan
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).
authors.forename: Zhi-Hai
authors.initials: ZH
authors.lastname: Peng
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland).
authors.forename: Lin
authors.initials: L
authors.lastname: Zhong
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D006509:Hepatitis B / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
references.citation: Nephrol Dial Transplant. 1995;10 Suppl 6:129-33
references.pmid: 8524484
references.citation: Liver Transpl. 2006 Sep;12(9):1347-56
references.pmid: 16741901
references.citation: Transplantation. 2014 Jul 27;98(2):216-21
references.pmid: 24621538
references.citation: Transplantation. 2010 Jul 15;90(1):52-60
references.pmid: 20626084
references.citation: Curr Opin Nephrol Hypertens. 2007 Nov;16(6):547-53
references.pmid: 18089969
references.citation: Transplant Proc. 2011 Apr;43(3):901-4
references.pmid: 21486624
references.citation: Am J Transplant. 2007 Jan;7(1):168-76
references.pmid: 17109735
references.citation: J Med Ethics. 1989 Mar;15(1):17-20
references.pmid: 2926781
references.citation: Liver Transpl. 2008 Jun;14(6):770-8
references.pmid: 18508369
references.citation: Lancet. 1984 May 12;1(8385):1077-8
references.pmid: 6144007
references.citation: Transplantation. 2008 Apr 15;85(7):935-42
references.pmid: 18408571
references.citation: Med Sci Monit. 2009 Dec;15(12):CR628-37
references.pmid: 19946234
references.citation: Transplant Proc. 2013;45(10):3640-3
references.pmid: 24314982
references.citation: Transpl Int. 2014 Jun;27(6):606-16
references.pmid: 24606223
references.citation: Ann Surg. 1998 Sep;228(3):411-20
references.pmid: 9742924
references.citation: Am J Transplant. 2012 Nov;12(11):2869-70
references.pmid: 23107268
references.citation: World J Gastroenterol. 2010 Aug 21;16(31):3878-87
references.pmid: 20712048
references.citation: J Hepatol. 2009 Nov;51(5):874-80
references.pmid: 19643508
references.citation: Transplant Proc. 2013 Jul-Aug;45(6):2307-13
references.pmid: 23871182
references.citation: Gut. 2011 May;60(5):702-9
references.pmid: 21325171
references.citation: Am J Transplant. 2012 Nov;12(11):3119-27
references.pmid: 22759208
references.citation: Am J Transplant. 2012 Nov;12(11):2901-8
references.pmid: 22822723
references.citation: Transplant Proc. 2011 Sep;43(7):2669-77
references.pmid: 21911144
references.citation: Liver Transpl. 2008 Oct;14 Suppl 2:S36-44
references.pmid: 18825724
references.citation: Transplant Proc. 2004 Jan-Feb;36(1):203-5
references.pmid: 15013346
references.citation: Vaccine. 2013 Dec 27;31 Suppl 9:J21-8
references.pmid: 23948229
references.citation: Am J Transplant. 2008 Nov;8(11):2243-51
references.pmid: 18808402
references.citation: Am J Transplant. 2006 Sep;6(9):2183-90
references.pmid: 16827789
references.citation: Clin Transplant. 2010 May-Jun;24(3):394-400
references.pmid: 19744093
references.citation: World J Gastroenterol. 2011 Mar 28;17(12):1531-7
references.pmid: 21472116
references.citation: Transplantation. 2012 Mar 15;93(5):530-5
references.pmid: 22245875
references.citation: J Clin Gastroenterol. 2004 Nov-Dec;38(10 Suppl 3):S158-68
references.pmid: 15602165
references.citation: Liver Transpl. 2003 Jul;9(7):741-7
references.pmid: 12827563
references.citation: Virology. 1988 Dec;167(2):630-3
references.pmid: 3201757
references.citation: Liver Transpl. 2012 Aug;18(8):914-29
references.pmid: 22467623
references.citation: Nephrol Dial Transplant. 2007 Sep;22 Suppl 8:viii5-viii8
references.pmid: 17890263