Outcomes of simultaneous liver kidney transplantation in patients with hepatocellular carcinoma

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Abstract

Background. The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications. Methods. We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regressionmodels. Propensity scorematching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding. Results. Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0% and 76.7% in the SLK-HCC group and 84.5% and 76.3% in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LTsurvival among all patients (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95% confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3% vs 10.5%, P = 0.36) and liver graft failure requiring re-transplantation (3.2% vs 2.3%, P = 0.44) compared with SLK-A patients. Conclusions. Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.

Original languageEnglish (US)
Pages (from-to)e12-e19
JournalTransplantation
Volume101
Issue number1
DOIs
StatePublished - 2017

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Liver Transplantation
Kidney Transplantation
Hepatocellular Carcinoma
Kidney
Liver
Confidence Intervals
Transplants
Propensity Score
End Stage Liver Disease
Mortality
Liver Failure
Kaplan-Meier Estimate
Registries
Survival Rate
Transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{9f6cba04cebc4f4ea3224d3fc5eaed50,
title = "Outcomes of simultaneous liver kidney transplantation in patients with hepatocellular carcinoma",
abstract = "Background. The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications. Methods. We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regressionmodels. Propensity scorematching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding. Results. Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0{\%} and 76.7{\%} in the SLK-HCC group and 84.5{\%} and 76.3{\%} in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LTsurvival among all patients (hazard ratio, 1.15; 95{\%} confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95{\%} confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3{\%} vs 10.5{\%}, P = 0.36) and liver graft failure requiring re-transplantation (3.2{\%} vs 2.3{\%}, P = 0.44) compared with SLK-A patients. Conclusions. Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.",
author = "Nicole Rich and Bekir Tanriover and Singal, {Amit G.} and Marrero, {Jorge A.}",
year = "2017",
doi = "10.1097/TP.0000000000001515",
language = "English (US)",
volume = "101",
pages = "e12--e19",
journal = "Transplantation",
issn = "0041-1337",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Outcomes of simultaneous liver kidney transplantation in patients with hepatocellular carcinoma

AU - Rich, Nicole

AU - Tanriover, Bekir

AU - Singal, Amit G.

AU - Marrero, Jorge A.

PY - 2017

Y1 - 2017

N2 - Background. The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications. Methods. We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regressionmodels. Propensity scorematching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding. Results. Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0% and 76.7% in the SLK-HCC group and 84.5% and 76.3% in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LTsurvival among all patients (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95% confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3% vs 10.5%, P = 0.36) and liver graft failure requiring re-transplantation (3.2% vs 2.3%, P = 0.44) compared with SLK-A patients. Conclusions. Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.

AB - Background. The frequency of simultaneous liver kidney (SLK) transplantation has increased following the implementation of the model for end-stage liver disease system for liver transplantation (LT). There is a paucity of data evaluating SLK outcomes in patients undergoing LT for hepatocellular carcinoma (HCC). Our aim was to compare outcomes between patients with HCC who underwent SLK and those who received SLK for other indications. Methods. We performed a retrospective analysis of adult recipients receiving SLK between 2002 and 2013 from the United Network for Organ Sharing registry. The primary outcome was posttransplant mortality. Patient survival was determined using Kaplan-Meier analysis and predictors of mortality were identified using proportional Cox hazard regressionmodels. Propensity scorematching was performed between SLK-HCC and SLK in the absence of HCC (SLK-A) groups to reduce confounding. Results. Between 2002 and 2013, 186 HCC patients underwent SLK-HCC and 3599 patients underwent SLK-A. The 1-year and 3-year survival rates were 89.0% and 76.7% in the SLK-HCC group and 84.5% and 76.3% in the SLK-A group (P = 0.20). In multivariable Cox regression, HCC was not associated with post-LTsurvival among all patients (hazard ratio, 1.15; 95% confidence interval, 0.84-1.58) or the propensity score-matched cohort (hazard ratio, 0.97; 95% confidence interval, 0.64-1.47). SLK-HCC patients had similar rates of acute rejection (13.3% vs 10.5%, P = 0.36) and liver graft failure requiring re-transplantation (3.2% vs 2.3%, P = 0.44) compared with SLK-A patients. Conclusions. Liver transplant candidates with advanced renal dysfunction and HCC may be considered for SLK.

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U2 - 10.1097/TP.0000000000001515

DO - 10.1097/TP.0000000000001515

M3 - Article

C2 - 28009759

AN - SCOPUS:85010190104

VL - 101

SP - e12-e19

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 1

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