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Long-Term Pediatric Outcomes of Simultaneous vs. Sequential Liver-Kidney Transplantation: A Review of the UNOS Database

K. Goli1, A. Rana1, J. Goss1, T. Miloh2

1Baylor College of Medicine/Texas Children's Hospital, Houston, TX, 2University of Miami, Houston, TX

Meeting: 2020 American Transplant Congress

Abstract number: 262

Keywords: Graft survival, Metabolic disease, Multivisceral transplantation, Polycystic kidney disease

Session Information

Session Name: Kidney Issues in Liver Transplantation

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 4:15pm-4:27pm

Location: Virtual

*Purpose: The long-term pediatric outcomes of simultaneous liver-kidney (SLK) transplantation and sequential liver and kidney transplantation, liver after kidney (LAK) and kidney after liver (KAL), remain to be further investigated.

*Methods: The UNOS database was queried for sequential and simultaneous liver and kidney transplants in pediatric (age<18yrs) recipients between 1988 and 2018. Multivisceral listings and retransplants were excluded. SLK transplants were defined as occurring ≤1 day apart. LAK and KAL were each defined as occurring >1 day apart. Patient survival was calculated from time of first transplant and graft survival was calculated since receipt of the second organ. Kaplan-Meier survival analysis compared SLK, LAK, and KAL, and log-rank tests were used to determine statistical significance. ANOVA and chi-square tests were used for univariate analyses.

*Results: Our study included 265 SLK, 42 LAK, 82 KAL pediatric transplant recipients. There was a significant patient survival benefit for KAL relative to SLK and LAK, with KAL resulting in a patient survival probability of 86% relative to 73% for SLK and 56% for LAK at 17 years post-transplant (p<0.0001, Figure 1). When adjusted for 16 covariates, including demographic factors and total time on waiting lists, KAL no longer displayed a significant survival benefit relative to SLK (p<0.77). For kidney graft survival, beginning at 4.5 years post-transplant, there was a significant (p<0.044) survival benefit for SLK relative to KAL and LAK. At 17 years post-transplant, SLK had the greatest kidney graft survival (59%) benefit relative to KAL (36%) and LAK (26%) (p<0.003). For liver graft survival, there was a significant survival benefit for KAL relative to SLK and LAK at all times (p<0.0001). At 16 years post-transplant, KAL showed a 75% survival probability, SLK showed a 56% survival probability, and LAK showed a 46% survival probability. Table 1: Patient Demographics and Clinical Indicators

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Figure 1

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*Conclusions: LAK has the worst outcomes, likely due to recurrent cholangitis or portal hypertension in patients who are already immunosuppressed after kidney transplant. Therefore, SLK should be considered.

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To cite this abstract in AMA style:

Goli K, Rana A, Goss J, Miloh T. Long-Term Pediatric Outcomes of Simultaneous vs. Sequential Liver-Kidney Transplantation: A Review of the UNOS Database [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-pediatric-outcomes-of-simultaneous-vs-sequential-liver-kidney-transplantation-a-review-of-the-unos-database/. Accessed May 9, 2025.

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