Outcomes of simultaneous liver/kidney transplants are equivalent to kidney transplant alone: A preliminary report

Steven I. Hanish, Milagros Samaniego, Joshua D. Mezrich, David P. Foley, Glen E. Leverson, David F. Lorentzen, Hans W. Sollinger, John D. Pirsch, Anthony M. D'Alessandro, Luis A. Fernandez

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background: With adoption of Model for End-Stage Liver Disease, the number of simultaneous liver-kidney transplants (SLK) has greatly increased. A recent registry study questioned the equity of allocating kidney transplants (KTx) simultaneously with liver transplantation due to poor outcomes (Locke et al., Transplantation 2008; 85: 935). Methods: To investigate outcome of KTx in SLK, all SLK (n=36) performed at our center from January 2000 to December 2007 were reviewed and KTx outcomes compared with those of kidney transplant alone (KTA) performed during that period (n=1283). We also reviewed whether pretransplant panel reactive antibody and donor-specific antibody affected KTx outcome in SLK. Results: One-and 3-year KTx and patient survival were not different between KTA and SLK regardless of sensitization level. There were 348 (27%) KTx failures in KTA vs. 6 (17%) in SLK (NS). Overall freedom from acute cellular rejection (ACR) and antibody-mediated rejection (AMR) in SLK was 93 and 96% at 3 years, compared with 72 and 78% in KTA (P=0.0105 and P=0.0744, respectively). Sensitized KTx recipients had more ACR and AMR (32 and 38%) at 3 years compared with nonsensitized recipients (28 and 20%) (P=0.23 and 0.0001, respectively). No differences in ACR and AMR were observed when SLK was divided and level of sensitization compared (P=0.17 and 0.65, respectively). Conclusion: SLK is a life-saving procedure with excellent patient and graft survival. AMR incidence in the KTx appears reduced in SLK compared with KTA regardless of level of preoperative panel reactive antibody. A high level of donor-specific antibody should not preclude simultaneous transplantation when clinically indicated.

Original languageEnglish (US)
Pages (from-to)52-60
Number of pages9
JournalTransplantation
Volume90
Issue number1
DOIs
StatePublished - Jul 15 2010
Externally publishedYes

Keywords

  • Acute cellular rejection
  • Antibody-mediated rejection.
  • Kidney transplant outcomes
  • Simultaneous liver-kidney transplantation

ASJC Scopus subject areas

  • Transplantation

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    Hanish, S. I., Samaniego, M., Mezrich, J. D., Foley, D. P., Leverson, G. E., Lorentzen, D. F., Sollinger, H. W., Pirsch, J. D., D'Alessandro, A. M., & Fernandez, L. A. (2010). Outcomes of simultaneous liver/kidney transplants are equivalent to kidney transplant alone: A preliminary report. Transplantation, 90(1), 52-60. https://doi.org/10.1097/TP.0b013e3181e17014