Evolving Frequency and Outcomes of Simultaneous Liver Kidney Transplants Based on Liver Disease Etiology

Background. The frequency of simultaneous liver kidney (SLK) transplantation is increasing. Data are scanty on outcomes of SLK transplants for liver disease etiology. Methods. Outcomes for liver and kidney grafts and patients survival at 5 years were compared for liver disease etiology among adults receiving SLK during 2002 and 2011 in the United States. Cox regression analysis models were built to determine the independent impact of liver disease etiology on outcomes. Results. A total of 2,606 patients (mean age 53 years, 69% males, 55% Caucasians) received SLK for primary biliary cirrhosis (PBC, n=76), primary sclerosing cholangitis (n=81), hepatitis C virus (HCV) (n=945), alcoholic liver disease (n=495), alcohol and HCV (n=152), cryptogenic cirrhosis (CC, n=289), nonalcoholic steatohepatitis (NASH) (n=221), hepatitis B virus (HBV) (n=98), and hepatocellular carcinoma (HCC) (n=249). HCV and NASH+CC contributed to about 44% and 9%, respectively, of all SLK transplants in 2002. Corresponding figures in 2011 were 34% and 22%, respectively. Compared to PBC, 5-year outcomes were worse for NASH, HCV, and HCC for liver graft (72%, 66%, and 72% vs. 82%; hazard ratio, HR: 2.5-3.1), kidney graft (71%, 65%, and 71% vs. 80%; HR: 2.3-2.8), and patient survival (74%, 69%, and 69% vs. 82%; HR: 2.4-2.7). Follow-up renal function assessed at 1, 3, and 5 years showed poor renal function among patients receiving SLK for HCV, NASH, CC, and HBV. Conclusions. Frequency of SLK transplants is increasing among NASH patients. Overall graft and patient outcomes are good. However, SLK for NASH, HCV, and HCC do worse. Strategies are needed to improve outcomes for SLK in HCV and NASH patients.