Simultaneous Liver-Kidney Transplantation versus Liver Transplantation in End-Stage Liver Disease Patients with...

The role of simultaneous liver-kidney transplantation (SLKT) in end-stage liver disease patients with varying kidney dysfunction remains unclear. This study aims to compare clinical outcomes of SLKT recipients with those undergoing liver transplant alone (LTA) with comparable kidney dysfunction.

This retrospective cohort study included the SLKT cohort (n = 52) from the Dutch Organ Transplantation Registration and the LTA cohort (n = 829) from Erasmus Medical Center between 2000 and 2020. Patients were stratified by pretransplant renal function (chronic kidney disease [CKD] stages 3b-5) and pretransplant renal replacement therapy (RRT) status. Patient and graft survival, and renal function were compared across renal function strata.

Across CKD stages 3b and 4, there was no statistically significant difference in overall survival rates (p = 0.59 and p = 0.23, respectively). For patients with CKD stage 5 or RRT, patient survival rates at 1, 3, and 5 years posttransplant were significantly lower in the LTA group (60.3%, 51.7%, and 51.7%, respectively) compared to the SLKT group (90.0%, 90.0%, and 80.8%, p = 0.048). Death-censored liver graft survival rates at 1, 3, and 5 years were also significantly lower in the LTA group (59.8%, 49.9%, and 49.9%) versus SLKT group (86.4%, 86.4%, and 77.0%, p = 0.048). Cox proportional hazards model confirmed the association between SLKT and improved patient survival (HR 0.31, 95% CI: 0.10-0.98, p = 0.046).

For patients with CKD stage 5 or those on pretransplant RRT, SLKT was associated with better survival outcomes compared to LTA. Primary etiology of liver disease and severity of kidney dysfunction should be considered when determining SLKT eligibility. Due to the limited group size, these findings should be interpreted with caution and further validated.