Optimizing Risk Assessment In Simultaneous Liver and Kidney Transplant: Donor and Recipient Factors Associated With Improved Outcome

Standardization in allocation of kidneys for transplant simultaneous with livers and the creation of a "safety net" for kidney transplant after liver transplant alone (LTA) was designed to encourage clinicians to list patients for LTA when the likelihood of renal recovery and the necessity of simultaneous liver and kidney (SLK) transplant were unclear. We analyzed the United Network for Organ Sharing database of SLK recipients starting January 1, 2015. Organs from one deceased donor were used in each individual case. Univariate analysis was used to analyze recipient and donor characteristics against patient and graft survival of at least 1 year. Cox regression was employed for multivariable analysis controlling for donor risk index variables. SLK recipients who failed to achieve 1 year of post-transplant survival were more likely to be older, have higher model for end-stage liver disease scores, have diabetes, have received dialysis within one week of transplant, and required intensive care unit admission at transplantation. Patients who failed to survive for at least 1 year after SLK were more likely to have received organs from donors who were older with a higher kidney donor profile index. Using national data we identified SLK donor and recipient characteristics associated with poor post-transplant outcome. Clinicians involved in the decision to list patients with liver failure for LTA or SLK may use these associations to help guide decision making.