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• W2079872425 abstract "Abstract Introduction The decision for isolated kidney transplant ( KT ) vs. combined liver–kidney transplant ( CLKT ) in patients with end‐stage renal disease ( ESRD ) with compensated cirrhosis remains controversial. We sought to determine outcomes of patients requiring listing for a liver transplant ( LT ) following either a cadaveric or living donor KT and compare these outcomes to similar patients receiving a CLKT . Methods Our dataset included the United Network for Organ Sharing ( UNOS )/Standard Transplant and Analysis and Research ( STAR ) kidney files from 1987 to 2012 after being joined with the liver files from 2002 to 2012. Outcomes of patients who received a CLKT with an international normalized ratio ( INR ) ≤1 and total bilirubin ≤1 were compared to patients who received a primary KT and subsequently required listing for LT between zero and five yr or after five yr. Results For the three groups, 244 patients had a CLKT , 216 were wait‐listed for LT between zero and five yr after KT (0–5 WL ), and 320 were wait‐listed five yr after KT (+5 WL ). From the time of KT , the 0–5 WL group had significantly worse survival than the CLKT group and the +5 WL group. The +5 WL had the best survival of all groups. For the 0–5 WL group, 45% underwent LT and 40% died while waiting compared to the +5 WL group with 53% having LT and 26% died while waiting. At the time of LT , the 0–5 WL group had a higher model for end‐stage liver disease ( MELD ) score, higher incidence of being in the ICU at the time of transplant, and higher incidence of requiring life support. From the time of LT , the CLKT trended toward better survival (p = 0.0549) than both the 0–5 WL and +5 WL groups, which had equivalent survival. Conclusion The 0–5 WL group is a higher risk group with poorer survival due to a higher incidence of dying on the waitlist. Better identification of patients with a high risk for hepatic decompensation following KT and agreement for regional exception for LT in the event of decompensation may improve utilization of organs and better survival for those patients." @default.
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• W2079872425 date "2014-12-01" @default.
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• W2079872425 title "Outcomes after combined liver-kidney transplant vs. kidney transplant followed by liver transplant" @default.
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• W2079872425 doi "https://doi.org/10.1111/ctr.12484" @default.
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