Trends and Outcomes in Simultaneous Liver and Kidney Transplantation in Australia and New Zealand

Douglas Drak, Nishanta Tangirala, Michael Fink, Leon A. Adams, Jonathan Fawcett, Gary P. Jeffrey, Mandy Byrne, Geoffrey McCaughan, Steve Chadban, Kate Wyburn, Germaine Wong, Wai H. Lim, David M. Gracey

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: Rates of simultaneous liver and kidney transplantation (SLKT) have increased, but indications for SLKT remain poorly defined. Additional data are needed to determine which patients benefit from SLKT to best direct use of scarce donor kidneys. Methods: Data were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) database for all SLKT performed until the end of 2017. Patients were divided by pretransplant dialysis status into no dialysis before SLKT (preemptive kidney transplant) and any dialysis before SLKT (nonpreemptive). Baseline characteristics and outcomes were compared. Results: Between 1989 and 2017, inclusive, 84 SLKT procedures were performed in Australia, of which 24% were preemptive. Preemptive and nonpreemptive SLKT recipients did not significantly differ in age (P = .267), sex (P = .526), or ethnicity (P = .870). Over a median follow-up time of 4.5 years, preemptively transplanted patients had a statistically equivalent risk of kidney graft failure (hazard ratio (HR) 1.83, 95% confidence interval [CI]: 0.36-12.86, P = .474) and all-cause mortality (HR 1.69, 95% CI: 0.51-5.6, P = .226) compared to nonpreemptive patients. Overall, 1- and 5-year survival rates for all SLKTs were 92% (95% CI: 86-96) and 60% (95% CI: 45-75), respectively. Conclusion: Kidney graft and overall patient survival were similar between patients with preemptive kidney transplant and those who were dialysis dependent.

Original languageEnglish
Pages (from-to)136-140
JournalTransplantation Proceedings
Volume53
Issue number1
DOIs
Publication statusPublished - Feb 2020

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