Simultaneous liver-kidney (SLKT) transplantation is an important option for liver transplant candidates with end stage renal disease (ESRD), sustained acute kidney injury (AKI) deemed unlikely to recover after LT and those with metabolic diseases such as primary hyperoxaluria. Since the adoption of MELD based allocation, the incidence rates of SLKT has increased from 2-3% to 8-9%. This has engendered controversy within the transplant community because SLKT draw deceased donor kidneys from the kidney transplant candidate pool. The decision for SLKT listing is straightforward for LT candidates with ESRD and metabolic disease. However, this decision becomes difficult among those who develop sustained AKI because it is difficult to predict renal recovery after liver transplant.
Although large observational studies generally show slightly improved survival in SLKT recipients compared with LT alone, inferences from these studies are limited by selection biases. Therefore, a true survival benefit of SLKT in candidates without ESRD is still unproven. The debate over appropriate SLKT is primarily one of the optimal kidney utilization versus the best interests of individual liver transplant candidates.
The goal of this multi-center alliance is to conduct observational studies with more granular data from different transplant centers to understand the listing practices, waitlist and post-transplant outcomes among SLKT candidates and recipients. The aims are as follows:
Aim 1: To understand the variability in listing practices for SLKT at different institution
a. Meet the OPTN criteria
b. ESRD/Sustained AKI/metabolic disease
c. Time trend in listing practices (2002-2008; 2009-2012; 2012-2017)
Aim 2: To examine the outcomes of SLKT candidates stratified by dialysis status on the transplant waiting list
d. Waitlist mortality
e. Predictors of waitlist mortality
Aim 3: To examine the short and long term outcomes of SLKT recipients stratified by dialysis status
g. Patient and liver and kidney graft survival
h. Kidney outcomes: rejection rates
i. Resource utilization
The data generated from these proposed study will provide the preliminary data for future prospective multi-center RO1 and UO1 grants