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One size does not fit all: Differential benefits of simultaneous liver-kidney transplantation by eligibility criteria.
One size does not fit all: Differential benefits of simultaneous liver-kidney transplantation by eligibility criteria. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Cheng, X. S., McElroy, L. M., Sanoff, S. L., Kwong, A. J. 2023Abstract
Standard eligibility criteria for simultaneous liver-kidney transplantation (SLK) are in place in the United States (US). We hypothesize that the benefit associated with SLK over liver transplant alone differs by patient, depending on the specific SLK criteria met. We analyzed a retrospective US cohort of 5,446 adult liver transplant or SLK recipients between January 1, 2015 and December 31, 2018 who potentially qualified for SLK. Exposure was receipt of SLK. We tested effect modification by the specific SLK eligibility criteria met (endstage kidney disease [ESKD], acute kidney injury [AKI], chronic kidney disease [CKD], or unknown). Primary outcome was death within 1 year of liver transplant. We used a modified Cox regression analysis containing an interaction term of SLK ? time from transplant. 210 (9%) SLK recipients and 351 (11%) liver-alone recipients died in 1 year. In the overall population, SLK was associated with a mortality benefit over liver transplant on the day of transplant, without adjustment (hazard ratio [HR] 0.59 [95% confidence interval [CI] 0.46-0.76]) and with adjustment (aHR 0.50 [95% CI 0.35-0.71]). However, when SLK eligibility criteria was included, only in patients with ESKD was SLK associated with a sustained survival benefit at day 0 (HR 0.17 [0.08-0.35]) up to 288 (95% CI 120-649) days posttransplant. Benefit within the first year posttransplant associated with SLK over liver-alone transplantation was only pronounced in patients with ESKD, but not present in patients meeting other criteria for SLK. A "strict SLK liberal Safety Net" strategy may warrant consideration at the national policy level.
View details for DOI 10.1097/LVT.0000000000000191
View details for PubMedID 37329171