Introduction: Simultaneous  liver kidney transplantation (SLKT) as a treatment option for patients with double organ failure was first described by Margreiter et al. at the Medical University of Innsbruck in 1984. We herein present outcomes and share insights from our 30-year experience with SLKT.
Methods: All consecutive adult SLKT recipients from 1984 until 2023 were included in the study. The primary study endpoints were graft- and patient survival. Secondary endpoints included risk factors for graft failure and patient death as well as incidence and risk factors for clinically relevant postoperative complications. Kaplan-Meier plots were used to analyze survival times. Uni- and multivariate analyses using Cox proportional hazards regression were conducted to assess graft- and patient survival endpoints.
Results: Eighty-three adult patients underwent SLKT during the study period. The median follow-up was 87 months. Five- and 10-year liver and kidney graft survival rates were 77.4% and 79.0%, and 67.7% and 69.8% respectively. Patient survival rates at 5- and 10-years were 81.4% and 77.4%. Univariate analysis revealed biliary complications [HR 2.59 (95% CI 1.02 – 6.54)], previous LT [HR 4.67 (95% CI 1.67 – 13.09)] and donor age [HR 1.03 (95% CI 1.01 – 1.06)] as risk factors for liver graft loss. In the multivariate analysis only donor age [HR 1.03 (95% CI 1.01 – 1.06)] remained as independent risk factor for graft loss. Independent risk factors for kidney graft loss were CIT [HR 1.13 per hourly increase (95% CI 1.03 – 1.25)] and recipient age [HR 1.09 (95% CI 1.03 – 1.16]. Primary liver graft non-function (PNF), hepatic artery thrombosis as well as older donor and recipient age were associated with worse overall survival. Only PNF remained as significant independent predictor of patient death. Patient transplanted in the MELD era exhibited worse survival rates compared to those transplanted in the pre-MELD era [HR 4.21 (95% CI 1.34 – 13.20)].
Conclusion: In selected patients, SLKT can lead to excellent long-term graft and patient survival rates. Prolonged kidney CIT, a potentially modifiable risk factor known to be associated with poor post-transplant outcomes, was found to be an independent predictor of kidney graft loss. The clinical advent of normothermic kidney machine perfusion may help ease logistics in SLKT and thus might lead to improved outcomes.