title: Outcomes of Simultaneous Liver Kidney Transplantation in Patients With Hepatocellular Carcinoma.
abstract: BACKGROUND
  The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications.
  
  
  METHODS
  We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regression models. Propensity score matching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding.
  
  
  RESULTS
  Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0% and 76.7% in the SLK-HCC group and 84.5% and 76.3% in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LT survival among all patients (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95% confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3% vs 10.5%, P = 0.36) and liver graft failure requiring re-transplantation (3.2% vs 2.3%, P = 0.44) compared with SLK-A patients.
  
  
  CONCLUSIONS
  Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.
authors.affiliation: 1 Digestive and Liver Diseases Division, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.2 Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rich
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult