Predisposing Factors of Diminished Survival in Simultaneous Liver/Kidney Transplantation

• Published in: American journal of transplantation Vol. 12; no. 11; pp. 2966 - 2973
• Main Authors: Hibi, T., Sageshima, J., Molina, E., Ciancio, G., Nishida, S., Chen, L., Arosemena, L., Mattiazzi, A., Guerra, G., Kupin, W., Tekin, A., Selvaggi, G., Levi, D., Ruiz, P., Livingstone, A. S., Roth, D., Martin, P., Tzakis, A., Burke, G. W.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2012; Wiley; Elsevier Limited
• Subjects: Adult; Age Factors; Biological and medical sciences; Causality; Cause of Death; Cohort Studies; Combined transplants; Confidence Intervals; Female; Graft Rejection; Graft Survival; Hepatitis C - diagnosis; Hepatitis C - epidemiology; Hepatitis C virus; Human viral diseases; Humans; Infectious diseases; Kaplan-Meier Estimate; kidney transplantation; Kidney Transplantation - methods; Kidney Transplantation - mortality; liver transplantation; Liver Transplantation - methods; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Sex Factors; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgery of the urinary system; survival; Survival Rate; Treatment Outcome; Viral diseases; Viral hepatitis; Graft(material); Prognosis; Liver; Concurrent; Hepatic disease; Homotransplantation; Kidney; Surgery; Predisposition; Graft; Combined transplants; Viral hepatitis C; Digestive system; Survival; Infection; Virus; Treatment; Urinary system; Viral disease; Risk factor; Digestive diseases; Flaviviridae; Hepatitis C virus; Hepacivirus; Kidney transplantation; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04121.x

Since the adoption of the Model for End‐Stage Liver Disease, simultaneous liver/kidney transplants (SLKT) have substantially increased. Recently, unfavorable outcomes have been reported yet contributing factors remain unclear. We retrospectively reviewed 74 consecutive adult SLKT performed at our center from 2000 to 2010 and compared with kidney transplant alone (KTA, N = 544). In SLKT, patient and death‐censored kidney graft survival rates were 64 ± 6% and 81 ± 5% at 5 years, respectively (median follow‐up, 47 months). Multivariable analyses revealed three independent risk factors affecting patient survival: hepatitis C virus positive (HCV+, hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.1–7.9), panel reactive antibody (PRA) > 20% (HR 2.8, 95% CI 1.1–7.2) and female donor gender (HR 2.9, 95% CI 1.1–7.9). For death‐censored kidney graft survival, delayed graft function was the strongest negative predictor (HR 8.3, 95% CI 2.5–27.9), followed by HCV+ and PRA > 20%. The adjusted risk of death‐censored kidney graft loss in HCV+ SLKT patients was 5.8 (95% CI 1.6–21.6) compared with HCV+ KTA (p = 0.008). Recurrent HCV within 1 year after SLKT correlated with early kidney graft failure (p = 0.004). Careful donor/recipient selection and innovative approaches for HCV+ SLKT patients are critical to further improve long‐term outcomes. In simultaneous liver–kidney transplant recipients, hepatitis C infection and pretransplant sensitization are significant negative predictors of patient and kidney graft survival, and early hepatitis C recurrence negatively impacts kidney graft survival. See editorial by Feng and Trotter on page 2869.