Center for Liver Disease and Transplantation Columbia University College of Physicians and Surgeons New York NY Division of Gastroenterology and Hepatology Michigan Medicine Ann Arbor MI Division of Gastroenterology and Hepatology and Preventative Medicine-Epidemiology Northwestern University Chicago IL Division of Gastroenterology and Hepatology University of California, San Francisco San Francisco CA Department of Internal Medicine Westchester Medical Center Westchester NY Division of Gastroenterology and Hepatology University of California, San Diego San Diego CA Division of Gastroenterology Duke University Durham NC Division of Gastroenterology and Hepatology University of California, Los Angeles Los Angeles CA Division of Gastroenterology and Hepatology University of Washington Seattle WA.
Liver Transpl. 2021 Nov;27(11):1613-1622. doi: 10.1002/lt.26232. Epub 2021 Aug 20.
We aimed to understand the contemporary changes in the characteristics and the determinants of outcomes among simultaneous liver-kidney transplantation (SLKT) recipients at 6 liver transplantation centers in the United States. We retrospectively enrolled SLKT recipients between 2002 and 2017 in the US Multicenter SLKT Consortium. We analyzed time-related trends in recipient characteristics and outcomes with linear regression and nonparametric methods. Clustered Cox regression determined the factors associated with 1-year and overall survival. We enrolled 572 patients. We found significant changes in the clinical characteristics of SLKT recipients: as compared with 2002, recipients in 2017 were older (59 versus 52 years; P < 0.001) and more likely to have chronic kidney disease (71% versus 33%; P < 0.001). There was a marked improvement in 1-year survival during the study period: 89% in 2002 versus 96% in 2017 (P < 0.001). We found that the drivers of 1-year mortality were SLKT year, hemodialysis at listing, donor distance, and delayed kidney allograft function. The drivers of overall mortality were an indication of acute kidney dysfunction, body mass index, hypertension, creatinine at SLKT, ventilation at SLKT, and donor quality. In this contemporary cohort of SLKT recipients, we highlight changes in the clinical characteristics of recipients. Further, we identify the determinants of 1-year and overall survival to highlight the variables that require the greatest attention to optimize outcomes.
我们旨在了解美国 6 家肝移植中心同时进行肝肾移植（SLKT）受者特征和结局的当代变化。我们回顾性地纳入了美国多中心 SLKT 联盟在 2002 年至 2017 年期间的 SLKT 受者。我们使用线性回归和非参数方法分析了受者特征和结局的时间相关趋势。聚类 Cox 回归确定了与 1 年和总生存相关的因素。我们共纳入了 572 名患者。我们发现 SLKT 受者的临床特征发生了显著变化：与 2002 年相比，2017 年的受者年龄更大（59 岁比 52 岁；P<0.001），且更有可能患有慢性肾脏病（71%比 33%；P<0.001）。研究期间 1 年生存率显著提高：2002 年为 89%，2017 年为 96%（P<0.001）。我们发现 1 年死亡率的驱动因素是 SLKT 年份、列入名单时的血液透析、供体距离和延迟的肾移植物功能。总死亡率的驱动因素是急性肾功能障碍、体重指数、高血压、SLKT 时的肌酐、SLKT 时的通气和供体质量的指征。在本当代 SLKT 受者队列中，我们强调了受者临床特征的变化。此外，我们确定了 1 年和总生存率的决定因素，以突出需要最大关注以优化结局的变量。
