Long-Term Outcomes and Trends in Simultaneous Liver-Kidney Transplantation: A Multicenter Cohort Study

Long-term outcomes after simultaneous liver-kidney transplantation (SLKT) are incompletely characterized. We aimed to estimate overall survival, survival with functioning grafts, kidney graft function over time, and temporal trends in SLKT practice.

Retrospective multicenter cohort of adults undergoing SLKT between 2003 and 2025 across 21 transplant centers in 7 Latin American countries. Overall survival and survival with functioning grafts were estimated up to 10 years after transplantation. Outcomes, recipient and donor characteristics were described across transplant eras.

Among 305 SLKT recipients, cirrhosis was the main liver indication (67.9%), whereas chronic kidney disease was the main renal indication (93.1%), most commonly due to polycystic kidney disease. Recipient profiles evolved over time toward greater metabolic burden, with more diabetes and MASLD, and increasing use of MELD exceptions - primarily for hepatocellular carcinoma - compared with earlier transplant eras. Overall survival was 78.5% at 1 year and 57.3% at 10 years, with 1-year survival exceeding 90% in 2022-2025; survival with functioning grafts was 77.4% and 50.9%, respectively. Early mortality predominated: 64% of deaths occurred in the first year, mainly due to bacterial infections (39%). Median eGFR among survivors remained in the mid-60s through 10 years.

SLKT achieved acceptable long-term patient, graft, and kidney function outcomes, with improved 1-year survival in recent eras. Early mortality remained concentrated in the first year and was often infection-related, highlighting an important target for post-transplant care as recipient metabolic complexity increases. These multicenter data provide long-term benchmarks to inform counseling and program planning amid an evolving metabolic burden.