title: SIMULTANEOUS LIVER KIDNEY TRANSPLANTATION IN LIVER TRANSPLANT CANDIDATES WITH RENAL DYSFUNCTION: IMPORTANCE OF CREATININE LEVELS, DIALYSIS, AND ORGAN QUALITY IN SURVIVAL.
abstract: The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK transplant survival has not been well described in the literature.
  
  
  
  The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N=2,700) or SLK (N=1,361) transplantation with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into four groups based on serum creatinine (Scr< 2 mg/dL versus Scr≥ 2 mg/dL) and dialysis status at listing and at transplant. The patients with end-stage renal disease and requiring acute dialysis more than three months before transplantation were excluded. A propensity score (PS)-matching was performed in each stratified groups to factor out imbalances between the SLK and LTA regarding covariates distribution and to reduce measured confounding. Donor quality was assessed with liver-donor risk index (L-DRI). The primary outcome of interest was post-transplant mortality.
  
  
  
  On multivariable PS-matched Cox proportional hazard models, SLK led to decrease in post-transplant mortality compared to LTA across all four groups, but only reached statistical significance (HR 0.77; 95% CI, 0.62-0.96) in the recipients not exposed to dialysis and Scr≥ 2 mg/dL at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, p=0.005). The decrease in mortality was observed among SLK recipients with better quality donors (L-DRI<1.5).
  
  
  
  Exposure to pre-transplantation dialysis and donor quality affected overall survival among SLK recipients.
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Malcolm P
authors.initials: MP
authors.lastname: MacConmara
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Justin
authors.initials: J
authors.lastname: Parekh
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Cristina
authors.initials: C
authors.lastname: Arce
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Song
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Ang
authors.initials: A
authors.lastname: Gao
authors.affiliation: Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Arjmand
authors.initials: A
authors.lastname: Mufti
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Swee-Ling
authors.initials: SL
authors.lastname: Levea
authors.affiliation: Booth School of Business, University of Chicago, Chicago, IL.
authors.forename: Burhaneddin
authors.initials: B
authors.lastname: Sandikci
authors.affiliation: Information Systems, the University of Texas at Dallas, Dallas, TX.
authors.forename: Mehmet U S
authors.initials: MU
authors.lastname: Ayvaci
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Venketash K
authors.initials: VK
authors.lastname: Ariyamuthu
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Christine
authors.initials: C
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Columbia University, College of Physicians & Surgeons, New York, NY.
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Department of Computer Science, Texas A&M, Commerce, TX.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Mete
authors.affiliation: Division of Nephrology, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Vazquez
authors.affiliation: Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero