Purpose: MELD based allocation and “Share 35” policy implementation has resulted in an overall increased incidence of renal failure at the time of liver transplantation, and a corresponding increase in simultaneous liver-kidney (SLK) transplants. Despite proposed guidelines, practice patterns for the use of SLK versus liver transplant alone (LTA) continue to have significant variation. We present our results with a restrictive approach to the use of SLK.

Methods: We performed a single center, retrospective review of adult liver transplants between 2012 and 2015, focused on a cohort of patients who required renal replacement therapy (RRT) in the preoperative period and then received a LTA. The decision to pursue either LTA or SLK was based on a comprehensive individualized clinical assessment.

Results: The overall rate of SLK was 7.0% (29/416 patients). 71 patients (12.1%) were on RRT at the time of transplant. 53 patients who were on RRT received a LTA, which represents our primary study group. 6 of these patients (11.3%) met criteria for SLK according to consensus guidelines (RRT > 4 weeks, or CKD with eGFR < 40 for > 3 months), yet given an LTA based on our evaluation. Mean RRT was 13.6 days (range 1-50) preoperatively, and 10.8 days postoperatively (range 1-95). Patients with renal failure were treated with calcineurin inhibitor avoidance strategies until resolution of good renal function. Mean eGFR at 3-, 6-, and 12-months postoperatively was 63.0, 48.0, and 51.6, respectively.

One-year survival for all 416 patients was 86.1%. Of those on RRT at the time of transplant, 1-year survival was significantly lower (P<0.01) for the LTA group (79.2%) compared to the SLK group (88.9%). In the primary study group, excluding those who died of multi-organ failure, all but 2 patients (96.2%) resolved their need for RRT.

Conclusions: In carefully selected patients on RRT at the time of transplant, restrictive use of SLK can achieve acceptable overall- and renal-outcomes. Calcineurin-free immunosuppressive strategies may be an important component to the resolution of renal function.

CITATION INFORMATION: Sultan S, Fitzpatrick S, Kozlowski T, Malik S, Hanish S, Bruno D, Weir M, Hutson W, Barth R, LaMattina J. Restrictive Approach to Simultaneous Liver Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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