Rejection Outcomes in Simultaneous Liver-Kidney Transplant versus Liver Transplant Alone in Recipients with Chronic Kidney Disease

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: As more patients with renal dysfunction receive liver transplants, chronic kidney disease (CKD) has been identified as a risk factor for post-transplant morbidity and mortality. Since the addition of serum creatinine in the Model of End Stage Liver Disease (MELD), the number of simultaneous liver kidney transplants (SLKT) have increased by 177% (Thompson, 2009). Despite the vast number of SLKTs performed across the country, there is no standardized immunosuppression (IS) strategy. Our study aims to compare outcomes of recipients of SLKT to liver transplant alone (LTA) with pre-existing CKD. Methods: This retrospective analysis evaluated SLKTs compared to LTAs with pre-existing CKD from January 2018-December 2023. LTA patients had diagnosed CKD with an estimated glomerular filtration rate (eGFR) of 30-44 mL/min/1.73 m2 (CKD stage 3b). The primary outcome was acute rejection (AR) within 1 year (antibody and T-cell mediated), and secondary outcomes included maintenance IS, AR treatment, infection, renal function, malignancy, and death, assessed for 1 year. Results: 51 SLKT patients and 31 LTA patients were included, with baseline characteristics evenly matched, however patients in the SLKT were younger with worse renal function (table 1). Table 2 contains secondary outcomes. Patients in the SLKT group had higher rates of AR compared to LTA (21.6 vs 12.8%; p=0.282). 3 drug IS regimens were more common in SLKT (27.5 vs 17.9%; p=0.291) and use of mammalian target of rapamycin inhibitors (mTORi) was higher in LTA (11.8 vs 43.6%; p<0.001). Tacrolimus troughs were significantly higher in the SLKT group at 6-12 months. Clostridiodes difficile infections and a composite infection endpoint (cytomegalovirus, blood stream, urinary tract, and intra-abdominal infections) were higher in SLKT (76.5 vs 59%; p=0.076). eGFR was significantly higher for the SLKT group through 1 year. LTA patients' eGFRs were maintained around their pre-LTA baseline. Malignancy and mortality rates were low, but the SLKT group had more deaths (2.6 vs 11.8%; p=0.134). Conclusions: Despite significantly improved eGFR post-transplant, the SLKT group suffered more complications including AR, infection, malignancy, and mortality, possibly in part due to differences in IS management. The SLKT group had greater IS requirements. This suggests that although there is evident renal benefit of SLKT, there may be unknown factors that heighten the risk of non-renal complications. Future studies can work to establish optimal IS regimens in this complex dual-organ population to help mitigate these risks. [Formula presented] CITATION INFORMATION: Stratton P., Fitzmaurice M., Jakupovic L., Moonka D., Tong M., Poparad-Stezar A. Rejection Outcomes in Simultaneous Liver-Kidney Transplant versus Liver Transplant Alone in Recipients with Chronic Kidney Disease AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: P. Stratton: None.

Volume

25

Issue

8

First Page

S773

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