Retrospective Study on Simultaneous Liver-Kidney Transplantation: Renal Outcome and Prevalence of Acute Rejection

There has been a long-standing hypothesis that simultaneous liver-kidney (SLK) transplantation has an immune protective effect on the transplanted kidney from the hepatic allograft. This hypothesis was challenged when recent data showed increased rejection rates for both liver and kidney grafts in patients with preexisting donor-specific antibodies (DSAs), particularly against class II HLA with mean fluorescence intensity (MFI) of >10,000.

We retrospectively collected clinical, biochemical, and outcome data on patients receiving SLK from 2014 to 2019 in King's College Hospital, London.

After a follow-up of 5 years, 18 patients (50%) achieved an eGFR greater than 45 mL/min/1.73 m². In total, there were 11 episodes of acute rejection (AR) in 9 patients. Antibody-mediated rejection was seen in 5 patients (13.8%), T-cell-mediated rejection was seen in 6 patients (16.7%), and 2 patients had both T-cell-mediated rejection and Antibody-mediated rejection. Renal allograft outcomes were analyzed based on the presence or absence of AR within the first year. At 1 month posttransplant, the mean eGFR was significantly higher in the non-AR group (52 mL/min/1.73 m²) compared with the AR group (33 mL/min/1.73 m²; P = .022). However, the mean eGFR at the 5-year benchmark in the non-AR group was 50 mL/min/1.73 m² compared with 40 mL/min/1.73 m² in the AR group and was not statistically significant anymore (P = .081).

Our findings show that SLK is a viable and effective treatment option for patients with concurrent liver and kidney diseases.