Evolving Frequency and Outcomes of Simultaneous Liver... : Transplantation (original) (raw)

Clinical and Translational Research

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

Singal, Ashwani K.1,2,5; Salameh, Habeeb3; Kuo, Yong-Fang4; Wiesner, Russell H.1

1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

2 Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL.

3 Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.

4 Department of Biostatistics, University of Texas Medical Branch, Galveston, TX.

5 Address correspondence to: Ashwani K. Singal, M.D., M.S., Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0012.

The authors declare no funding or conflicts of interest.

E-mail: [email protected]

A.K.S. participated in making the study design, analyzing the data, and writing the final draft of the article. S.H. participated in compiling the data and writing the initial draft of the article. Y.-F.K. participated in performing statistical analysis and writing the statistical section of the article. R.H.W. participated in designing the study and approving the final draft of the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 21 October 2013. Revision requested 8 November 2013.

Accepted 2 January 2014.

Abstract

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.