Results of Simultaneous Liver and Kidney Transplantation: A Single-Center Review.
The decision for a simultaneous liver and kidney transplantation (SLKT) is fraught with controversy. The aim of this study was to compare SLKT with liver transplantation alone (LTA) in patients with pretransplantation renal failure.



A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed.



Of 1,129 liver transplantations, 132 had renal failure pretransplantation; 52 had SLKT and 80 recipients had LTA. Model for End-Stage Liver Disease score and BMI were lower in the SLKT group (p = 0.001). Simultaneous liver and kidney transplantation patients had better overall survival rates at 1 and 5 years compared with LTA (92.3% and 81.6% vs 73.3% and 64.3% respectively; p < 0.01). Graft survival was also superior in patients undergoing SLKT vs LTA. Six of 52 (11.5%) SLKT patients had final positive cross match, but only 1 of 52 (1.9%) kidney grafts was lost to rejection. In the SLKT group, 9 of 52 (17.3%) patients required dialysis post transplantation, but only 2 remained on dialysis beyond 30 days. All patients in the LTA group were on dialysis pretransplantation and significantly more patients (52 of 80 [65%]) required dialysis post LTA (p ≤ 0.0001); 31 of 80 (38.8%) were dialysis dependent for more than 30 days or died on dialysis within 30 days. Two LTA recipients were subsequently listed for kidney transplant.



Patients with end-stage liver disease on dialysis who undergo liver transplantation have significantly better survival when SLKT is performed. In selected patients, SLKT is an appropriate use of a scarce resource, but better prognostic indicators for selection of patients are still needed.
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO. Electronic address: doylem@wustl.edu.
M B Majella
MB
Doyle
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Vijay
V
Subramanian
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Neeta
N
Vachharajani
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Erin
E
Maynard
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Surendra
S
Shenoy
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Jason R
JR
Wellen
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
Yiing
Y
Lin
Department of Surgery, Section of Abdominal Transplantation, Washington University School of Medicine, St Louis, MO.
William C
WC
Chapman
D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome