Results of Simultaneous Liver and Kidney Transplantation: A Single-Center Review

MB Majella Doyle, Vijay Subramanian, Neeta Vachharajani, Erin Maynard, Surendra Shenoy, Jason R. Wellen, Yiing Lin, William C. Chapman

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: 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. Study Design: A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed. Results: 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. Conclusions: 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.

Original languageEnglish (US)
JournalJournal of the American College of Surgeons
DOIs
StateAccepted/In press - Jan 9 2016
Externally publishedYes

Fingerprint

Liver Transplantation
Kidney Transplantation
Dialysis
Renal Insufficiency
End Stage Liver Disease
Transplants
Kidney
Graft Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Results of Simultaneous Liver and Kidney Transplantation : A Single-Center Review. / Doyle, MB Majella; Subramanian, Vijay; Vachharajani, Neeta; Maynard, Erin; Shenoy, Surendra; Wellen, Jason R.; Lin, Yiing; Chapman, William C.

In: Journal of the American College of Surgeons, 09.01.2016.

Research output: Contribution to journalArticle

Doyle, MB Majella ; Subramanian, Vijay ; Vachharajani, Neeta ; Maynard, Erin ; Shenoy, Surendra ; Wellen, Jason R. ; Lin, Yiing ; Chapman, William C. / Results of Simultaneous Liver and Kidney Transplantation : A Single-Center Review. In: Journal of the American College of Surgeons. 2016.
@article{462e8a69d81e4948a548e83ab6d19f6d,
title = "Results of Simultaneous Liver and Kidney Transplantation: A Single-Center Review",
abstract = "Background: 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. Study Design: A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed. Results: 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. Conclusions: 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.",
author = "Doyle, {MB Majella} and Vijay Subramanian and Neeta Vachharajani and Erin Maynard and Surendra Shenoy and Wellen, {Jason R.} and Yiing Lin and Chapman, {William C.}",
year = "2016",
month = "1",
day = "9",
doi = "10.1016/j.jamcollsurg.2016.04.005",
language = "English (US)",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Results of Simultaneous Liver and Kidney Transplantation

T2 - A Single-Center Review

AU - Doyle, MB Majella

AU - Subramanian, Vijay

AU - Vachharajani, Neeta

AU - Maynard, Erin

AU - Shenoy, Surendra

AU - Wellen, Jason R.

AU - Lin, Yiing

AU - Chapman, William C.

PY - 2016/1/9

Y1 - 2016/1/9

N2 - Background: 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. Study Design: A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed. Results: 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. Conclusions: 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.

AB - Background: 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. Study Design: A retrospective review comparing patients undergoing SLKT and LTA (with renal failure) between January 2000 and December 2014 was performed. Results: 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. Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=84969548883&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84969548883&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2016.04.005

DO - 10.1016/j.jamcollsurg.2016.04.005

M3 - Article

C2 - 27103549

AN - SCOPUS:84969548883

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

ER -