Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

Bekir Tanriover*, Malcolm P. MacConmara, Justin Parekh, Cristina Arce, Song Zhang, Ang Gao, Arjmand Mufti, Swee Ling Levea, Burhaneddin Sandikci, Mehmet U.S. Ayvaci, Venketash K. Ariyamuthu, Christine Hwang, Sumit Mohan, Mutlu Mete, Miguel A. Vazquez, Jorge A. Marrero

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

Introduction 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 survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into 4 groups based on serum creatinine (<2 mg/dl versus ≥2 mg/dl) and dialysis status at listing and transplant. The patients with end-stage renal disease and requiring acute dialysis more than 3 months before transplantation were excluded. A propensity score matching was performed in each stratified group to factor out imbalances between the SLK and LTA regarding covariate distribution and to reduce measured confounding. Donor quality was assessed with liver donor risk index. The primary outcome of interest was posttransplant mortality. Results In multivariable propensity score-matched Cox proportional hazard models, SLK led to decrease in posttransplant mortality compared with LTA across all 4 groups, but only reached statistical significance (hazard ratio 0.77; 95% confidence interval, 0.62–0.96) in the recipients not exposed to dialysis and serum creatinine ≥ 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 (liver donor risk index < 1.5). Discussion Exposure to pretransplantation dialysis and donor quality affected overall survival among SLK recipients.

Original languageEnglish
Pages (from-to)221-229
Number of pages9
JournalKidney International Reports
Volume1
Issue number4
DOIs
Publication statusPublished - 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 International Society of Nephrology

Funding

The data reported here have been supplied by the Minneapolis Medical Research Foundation as the contractor for the Scientific Registry of Transplant Recipients. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the Scientific Registry of Transplant Recipients or the US Government. This research is partly supported by the UT Southwestern O’Brien Kidney Research Core Center (Grant number: P30DK079328).

FundersFunder number
UT Southwestern O’Brien Kidney Research Core CenterP30DK079328

    Keywords

    • deceased donor quality
    • dual organ allocation
    • propensity score matching
    • simultaneous liver-kidney transplantation
    • UNOS

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