Background: We evaluated the concept of whether liver failure patients with a superimposed kidney injury receiving a simultaneous liver and kidney transplant (SLKT) have similar outcomes compared to patients with liver failure without a kidney injury receiving a liver transplantation (LT) alone. Methods: Using data from the United Network of Organ Sharing (UNOS) database, patients were divided into five groups based on pre-transplant model for end-stage liver disease (MELD) scores and categorized as not having (serum creatinine (sCr) <= 1.5 mg/dL) or having (sCr > 1.5 mg/dL) renal dysfunction. Of 30,958 patients undergoing LT, 14,679 (47.5%) had renal dysfunction, and of those, 5,084 (16.4%) had dialysis. Results: Survival in those (liver failure with renal dysfunction) receiving SLKT was significantly worse (P < 0.001) as compared to those with sCr < 1.5 mg/dL (liver failure only). The highest mortality rate observed was 21% in the 36+ MELD group with renal dysfunction with or without SLKT. In high MELD recipients (MELD > 30) with renal dysfunction, presence of renal dysfunction affects the outcome and SLKT does not improve survival. In low MELD recipients (16 - 20), presence of renal dysfunction at the time of transplantation does affect post-transplant survival, but survival is improved with SLKT. Conclusions: SLKT improved 1-year survival only in low MELD (16 - 20) recipients but not in other groups. Performance of SLKT should be limited to patients where a benefit in survival and post-transplant outcomes can be demonstrated.
| Identifer | oai:union.ndltd.org:arizona.edu/oai:arizona.openrepository.com:10150/625529 |
| Date | January 2017 |
| Creators | Habib, Shahid, Khan, Khalid, Hsu, Chiu-Hsieh, Meister, Edward, Rana, Abbas, Boyer, Thomas |
| Contributors | Univ Arizona, Mel & Enid Zuckerman Coll Publ Hlth, Div Epidemiol & Biostat, Univ Arizona, Dept Med & Surg, Div Gastroenterol, Liver Res Inst,Coll Med, Univ Arizona, Dept Med & Surg, Div Hepatol, Liver Res Inst,Coll Med, Univ Arizona, Dept Med & Surg, Div Liver Transplantat, Liver Res Inst,Coll Med |
| Publisher | ELMER PRESS INC |
| Source Sets | University of Arizona |
| Language | English |
| Detected Language | English |
| Type | Article |
| Rights | Articles © The authors | Journal compilation © Gastroenterol Res and Elmer Press Inc™ | This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License. |
| Relation | http://www.gastrores.org/index.php/Gastrores/article/view/803 |
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