For Pediatric Patients Listed for Simultaneous Liver-Kidney Transplantation, Those Who Received Both a Liver and a Kidney Transplant Had Significantly Better Graft and Patient Survival Than Those Who Received Only a Liver Transplant.

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. Due to their small size, impaired growth, and more robust immune systems, children with kidney failure listed for SLK may be at increased risk, especially if they do not receive a simultaneous kidney transplant. We hypothesized that pediatric patients listed for SLK will have worse outcomes than adults, especially those who received a LA. Methods: Using UNOS STAR files, all 4867 patients listed for both a liver and a kidney from 7/1988 to 10/2012 were analyzed. There were 4033 adult SLK transplants (Adult and SLK), 591 adult LA transplants (Adult and LA), 199 pediatric SLK transplants (PEDS and SLK), and 44 pediatric LA transplants (PEDS and LA). Kaplan Meier analysis, the log rank test, and Cox multivariate analysis were used. Results: In adult and pediatric recipients listed for SLK, patient and liver graft survival was significantly lower in those who received only LA.Figure: No Caption available.In the multivariate model, compared to PEDS and SLK, transplant era, recipient age, recipient and donor gender, and Adult and SLK (RR = 1.2, p = 0.3) were not statistically significant risk factors. However, Adult and LA (RR = 2.4, p < 0.0001) and PEDS and LA (RR =4.0, p < 0.0001) were statistically significant risk factors for worse patient and liver graft survival compared to recipients of PEDS and SLK. In addition, donor age (RR = 1.014, p < 0.0001), cold ischemia time (1.014, p = 0.03), and DCD (RR = 1.6, p = 0.001) were statistically significant risk factors. Conclusions: Both children and adults listed for simultaneous liver kidney transplants who received a LA had significantly inferior patient and liver graft survival compared to children and adults who received a SLK. Donor age, CIT, and DCD also appeared to be important risk factors in this population.