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Published on: November 7, 2020
Temporal Trends and Evolving Outcomes After Simultaneous Liver-Kidney Transplantation: Results from the US SLKT
Giuseppe Cullaro1, Pratima Sharma, Jennifer Jo
1Center for Liver Disease and Transplantation Columbia University College of Physicians and Surgeons New York NY Division of Gastroenterology and Hepatology Michigan Medicine Ann Arbor MI Division of Gastroenterology and Hepatology and Preventative Medicine-Epidemiology Northwestern University Chicago IL Division of Gastroenterology and Hepatology University of California, San Francisco San Francisco CA Department of Internal Medicine Westchester Medical Center Westchester NY Division of Gastroenterology and Hepatology University of California, San Diego San Diego CA Division of Gastroenterology Duke University Durham NC Division of Gastroenterology and Hepatology University of California, Los Angeles Los Angeles CA Division of Gastroenterology and Hepatology University of Washington Seattle WA.
Abstract:
We aimed to understand the contemporary changes in the characteristics and the determinants of outcomes among simultaneous liver-kidney transplantation (SLKT) recipients at 6 liver transplantation centers in the United States. We retrospectively enrolled SLKT recipients between 2002 and 2017 in the US Multicenter SLKT Consortium. We analyzed time-related trends in recipient characteristics and outcomes with linear regression and nonparametric methods. Clustered Cox regression determined the factors associated with 1-year and overall survival. We enrolled 572 patients. We found significant changes in the clinical characteristics of SLKT recipients: as compared with 2002, recipients in 2017 were older (59 versus 52 years; P < 0.001) and more likely to have chronic kidney disease (71% versus 33%; P < 0.001). There was a marked improvement in 1-year survival during the study period: 89% in 2002 versus 96% in 2017 (P < 0.001). We found that the drivers of 1-year mortality were SLKT year, hemodialysis at listing, donor distance, and delayed kidney allograft function. The drivers of overall mortality were an indication of acute kidney dysfunction, body mass index, hypertension, creatinine at SLKT, ventilation at SLKT, and donor quality. In this contemporary cohort of SLKT recipients, we highlight changes in the clinical characteristics of recipients. Further, we identify the determinants of 1-year and overall survival to highlight the variables that require the greatest attention to optimize outcomes.
