For Patients Listed for Simultaneous Liver Kidney Transplants, Retransplantation Has Significantly Inferior Liver Graft and Patient Survival Compared to Primary Simultaneous Liver Kidney Transplantation.

Abstract

Body: Based on an intention to treat model, we have shown that simultaneous liver kidney (SLK) transplantation offers significantly better graft and patient survival than liver transplantation alone (LA) in patients listed for SLK. SLK transplantation in the setting of retransplantation may increase risk due to increased surgical difficulty, cold ischemia time, and immunological risk. We hypothesized that retransplants (ReTx) will have worse outcomes in patients listed for SLK transplants. Methods: Using UNOS STAR files, all 4867 patients listed for SLK from 7/1988 to 10/2012 were analyzed. There were 4091 SLK primary transplants (SLK and No ReTx), 596 LA primary transplants (LA and No ReTx), 141 SLK retransplants (SLK and ReTx), and 39 LA retransplants (LA and ReTx). Kaplan Meier analysis, the log rank test, and Cox multivariate analysis were used. Results: In patients listed for a SLK, there was significantly lower patient and liver graft survival in ReTx compared to primary SLK.Figure: No Caption available.Table: No Caption available.In the multivariate model, era, pediatric, and recipient and donor gender were not statistically significant risk factors. However, LA and no ReTx (RR = 1.9, p < 0.0001), SLK and ReTx (RR = 1.6, p < 0.0001), LA and ReTx (RR = 3.8, p < 0.0001) were statistically significant risk factors for worse graft survival. In addition, donor age (RR = 1.014, p < 0.0001), recipient age (RR < 1.007, p < 0.01), DCD (RR = 1.7, p < 0.0001) and cold ischemia (1.015, p = 0.03) were significant risk factors. Conclusions: For patients listed for SLK, retransplantation, especially LA retransplantation, results in significantly inferior patient and liver graft survival compared to primary SLK. Recipient and donor age, DCD, and CIT also appear to be important risk factors in this population.