Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
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Comparative Study
Propensity score-based survival benefit of simultaneous liver-kidney transplant over liver transplant alone for recipients with pretransplant renal dysfunction.
The survival benefit of simultaneous liver-kidney transplantation (SLKT) over liver transplantation alone (LTA) is unclear from the current literature. Additionally, the role of donor kidney quality, measured by the kidney donor risk index (KDRI), in survival benefit of SLKT is not studied. We compared survival benefit after SLKT and LTA among recipients with similar pretransplant renal dysfunction using novel methodology, specifically with respect to survival probability and area under the survival curve by dialysis status and KDRI. ⋯ In conclusion, the propensity score-adjusted survival among SLKT and LTA recipients was similar for those who were on dialysis at LT. Although statistically significant, the survival advantage of SLKT over LTA was of marginal clinical significance among patients not on dialysis and occurred only if the donor kidney was of sufficient quality. These results should be considered in the ongoing debate regarding the allocation of kidneys to extra-renal transplant candidates.