Simultaneous Liver-Kidney Transplantation in Adults: A Single-center Experience Comparing Results With Isolated Liver Transplantation.

Abstract

BACKGROUND:

After introduction of the Model for End-Stage Liver Disease (MELD) score in 2002, a worldwide increasing number of simultaneous liver-kidney transplantations (SLKTx) has been observed. However, organ shortage puts into question the allocation of 2 grafts to 1 recipient. This retrospective, single-center study compared SLKTx results with isolated liver transplantation (LTx).

METHODS:

Between 1995 and 2013, 37 SLKTx were performed in adult recipients. Every SLKTx was matched by donor age (±5 years) and transplantation date with 2 LTx (n = 74). Pretransplant, intraoperative, and post-transplant variables were collected; liver graft and patient survivals were calculated.

RESULTS:

As expected, donor age was similar in the 2 groups (median, 39.7 years), whereas serum creatinine level, glomerular filtration rate, and MELD and D-MELD (donor age*MELD) scores were significantly higher in the SLKTx group. SLKTx had longer waiting list time (P = .0034) as well as higher surgical difficulty, testified by more blood transfusions (P = .0083), increased use of classic caval reconstruction (P = .0024), and more frequent need of abdominal packing for bleeding control (P = .0003). In addition, duration of hospital stay (P < .0001), second-look surgery (P = .0082), post-transplant dialysis (P < .0001), and post-transplant infections (P = .04) were significantly greater in SLKTx group. Acute rejection episodes involving the liver were significantly less in SLKTx than in LTx (14% vs 41%; P = .0045). Liver graft and patient survival at 10 years after transplantation was similar in the 2 groups (liver graft: SLKTx, 80% vs LTx, 77% [P = .85]; patient: SLKTx, 86% vs LTx, 79% [P = .56]).

CONCLUSIONS:

Despite being technically challenging, SLKTx provided excellent long-term results and was shown to be an effective use of liver grafts.

• Authors: G Catalano, F Tandoi, E Mazza, F Simonato, G Tognarelli, L Biancone, F Lupo, R Romagnoli, M Salizzoni
• Journal: Transplantation proceedings (Transplant Proc) Vol. 47 Issue 7 Pg. 2156-8 (Sep 2015) ISSN: 1873-2623 [Electronic] United States
• PMID: 26361666 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Case-Control Studies
• Combined Modality Therapy (methods, statistics & numerical data)
• Female
• Glomerular Filtration Rate
• Graft Survival
• Humans
• Kidney Transplantation (methods, statistics & numerical data)
• Liver Diseases (pathology, surgery)
• Liver Transplantation (methods, statistics & numerical data)
• Male
• Middle Aged
• Postoperative Complications (epidemiology, etiology)
• Retrospective Studies
• Severity of Illness Index
• Tissue and Organ Procurement (methods)
• Treatment Outcome
• Young Adult