Waitlist and post‐transplant outcomes among candidates listed for liver transplant: Liver alone versus simultaneous liver kidney listings

• Published in: Alimentary pharmacology & therapeutics Vol. 58; no. 9; pp. 929 - 937
• Main Authors: Singal, Ashwani K., Kuo, Yong‐Fang
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01.11.2023
• Subjects: Cirrhosis; Creatinine; Epidermal growth factor receptors; Hemodialysis; Kidney diseases; Kidney transplantation; Liver; Liver transplantation; Mortality; Renal function; Survival; Transplants & implants
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.17700

Summary Background Data comparing waitlist and post‐transplant outcomes of liver transplantation (LT) alone (LTA) versus simultaneous liver kidney (SLK) listings are limited. Aim To examine 90‐days waitlist and 1‐year post‐transplant outcomes of LT listings since Organ Procurement Transplant Network (OPTN) policy for SLK, who had cirrhosis with eGFR <30 mL/min or on dialysis at listing. Methods Adults (08/2017–03/2021) with first LT listing (2628 SLK) were stratified on renal function from listing: acute kidney injury (AKI): rise of serum creatinine by ≥0.3 mg/dL or <42 days hemodialysis; chronic kidney disease (CKD): eGFR <60 mL/min for ≥90 days or ≥42 days hemodialysis. Results Among 7094 adults analyzed, 90‐days competing cumulative waitlist mortality was 18.2% in LTA + CKD ( n  = 37), 15.3% in LTA + AKI ( n  = 3337), 15% in SLK + AKI ( n  = 2070), and 11% in SLK + CKD ( n  = 403), p  < 0.001. On fine and gray model, compared to SLK + CKD, LTA + AKI had 1.4–fold waitlist mortality. On a median post‐transplant follow up of 1 year, patient survival was similar comparing LTA versus SLK for AKI (89% each, p  = 0.83), for CKD (93 vs. 86%, p  = 0.55), but lower in recipients listed for SLK with no AKI or CKD (93 vs. 88%, p  = 0.02), adjusted hazard ratio (95% CI) of 0.7 (0.4–1.2). Among 1024 LTA recipients without AKI or CKD from listing, 117 were listed for SLK, and their 1‐year survival was poorer compared to LT alone listings (79 vs. 95%, p  < 0.002, adjusted HR 3.6 (1.3–10.3); p  = 0.015). Conclusions Among candidates with renal dysfunction at listing for LT, those listed for LT alone should receive transplant promptly to optimise waitlist outcomes. Those listed for SLK should wait to receive both organs to optimise post‐transplant outcomes.