Trends and Outcomes in Simultaneous Liver and Kidney Transplantation in Australia and New Zealand |
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| Authors: | Douglas Drak Nishanta Tangirala Michael Fink Leon A Adams Jonathan Fawcett Gary P Jeffrey Mandy Byrne Geoffrey McCaughan Steve Chadban Kate Wyburn Germaine Wong Wai H Lim David M Gracey |
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| Institution: | 1. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia;2. Nephrology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia;3. Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia;4. Medical School, The University of Western Australia, Perth, Western Australia, Australia;5. Department of Hepatology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia, Australia;6. Princess Alexandra Hospital, Brisbane, Queensland, Australia;7. School of Medicine, The University of Queensland, Brisbane, Australia;8. Victorian Liver Transplant Unit, Heidelberg, Victoria, Australia;9. Central Clinical School, University of Sydney, Sydney, New South Wales, Australia;10. Liver Injury and Cancer, Centenary Institute, Camperdown, New South Wales, Australia;11. Centre for Kidney Research, School, Children’s Hospital at Westmead, Westmead, New South Wales, Australia;12. Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia;13. Holdsworth House Medical Practice, Sydney, New South Wales, Australia |
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| Abstract: | AimRates of simultaneous liver and kidney transplantation (SLKT) have increased, but indications for SLKT remain poorly defined. Additional data are needed to determine which patients benefit from SLKT to best direct use of scarce donor kidneys.MethodsData were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) database for all SLKT performed until the end of 2017. Patients were divided by pretransplant dialysis status into no dialysis before SLKT (preemptive kidney transplant) and any dialysis before SLKT (nonpreemptive). Baseline characteristics and outcomes were compared.ResultsBetween 1989 and 2017, inclusive, 84 SLKT procedures were performed in Australia, of which 24% were preemptive. Preemptive and nonpreemptive SLKT recipients did not significantly differ in age (P = .267), sex (P = .526), or ethnicity (P = .870). Over a median follow-up time of 4.5 years, preemptively transplanted patients had a statistically equivalent risk of kidney graft failure (hazard ratio (HR) 1.83, 95% confidence interval CI]: 0.36-12.86, P = .474) and all-cause mortality (HR 1.69, 95% CI: 0.51-5.6, P = .226) compared to nonpreemptive patients. Overall, 1- and 5-year survival rates for all SLKTs were 92% (95% CI: 86-96) and 60% (95% CI: 45-75), respectively.ConclusionKidney graft and overall patient survival were similar between patients with preemptive kidney transplant and those who were dialysis dependent. |
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