Introduction:The advent of MELD scoring resulted in an increase in the number of simultaneous liver-kidney transplants (SLKT) being performed due to the higher priority weighting towards patients with endstage liver disease and renal insufficiency. The controversy centers around the contention that SLKT takes away younger, good quality deceased donor kidneys from an already overburdened kidney waitlist and allocates them to liver transplant recipients for unclear benefit. This study looks at overall patient and graft survival comparing organs procured from standard criteria donors and those from donors with extended criteria kidneys(ECD).

Methods:This is a retrospective, single centre study looking at all SLKT done between November 2006 and April 2012 at The Piedmont Transplant Institute. There were 50 SLKT performed, 4 of these received organs from ECD kidney donors as defined by current UNOS definitions.Survival outcomes were analyzed using logrank test

Results: There was a statistically significant difference in 1 and 3 year patient survival comparing recipients of SCD (group 1) vs ECD kidneys(group 2).

1 and 3 year liver and kidney allograft survival was also inferior in patients receiving an ECD kidney.

Conclusions: Overall, SLKT has excellent 1 and 3 year graft and patient survival. Although the sample size is small, donors that meet ECD kidney criteria should be used judiciously as there appears to be a significantly worsened outcome in both patient, liver, and kidney graft survival.

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