Outcomes and native renal recovery following simultaneous liver-kidney transplantation

Am J Transplant. 2012 Nov;12(11):2949-57. doi: 10.1111/j.1600-6143.2012.04182.x. Epub 2012 Jul 3.


With the increase in patients having impaired renal function at liver transplant due to MELD, accurate predictors of posttransplant native renal recovery are needed to select candidates for simultaneous liver-kidney transplantation (SLK). Current UNOS guidelines rely on specific clinical criteria for SLK allocation. To examine these guidelines and other variables predicting nonrecovery, we analyzed 155 SLK recipients, focusing on a subset (n = 78) that had post-SLK native GFR (nGFR) determined by radionuclide renal scans. The 77 patients not having renal scans received a higher number of extended criteria donor organs and had worse posttransplant survival. Of the 78 renal scan patients, 31 met and 47 did not meet pre-SLK UNOS criteria. The UNOS criteria were more predictive than our institutional criteria for all nGFR recovery thresholds (20-40 mL/min), although at the most conservative cut-off (nGFR ≤ 20) it had low sensitivity (55.3%), specificity (75%), PPV (67.6%) and NPV (63.8%) for predicting post-SLK nonrecovery. On multivariate analysis, the only predictor of native renal nonrecovery (nGFR ≤ 20) was abnormal pre-SLK renal imaging (OR 3.85, CI 1.22-12.5). Our data support the need to refine SLK selection utilizing more definitive biomarkers and predictors of native renal recovery than current clinical criteria.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Analysis of Variance
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Graft Rejection
  • Graft Survival
  • Humans
  • Kidney / diagnostic imaging*
  • Kidney / pathology
  • Kidney Function Tests
  • Kidney Transplantation / adverse effects
  • Kidney Transplantation / methods*
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Living Donors
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Selection*
  • Postoperative Care / methods
  • Preoperative Care / methods
  • Radionuclide Imaging
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Treatment Outcome