Propensity Score-Based Survival Benefit of Simultaneous Liver-Kidney Transplant over Liver Transplant Alone for Recipients with XXXX .

@entity1 @entity8 @entity27973
UNASSIGNED: Survival benefit of simultaneous liver-kidney transplant (SLKT) over liver transplant alone (LTA) is unclear from the current literature. Additionally, the role of donor kidney quality, measured by 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 pre-transplant @entity8 using novel methodology, specifically with respect to survival probability and area under the survival curve by dialysis status and KDRI. METHODS: Data were obtained from the Scientific Registry of Transplant Recipients. The study cohort included @entity1 with pre-LT @entity8 who were waitlisted and received either a SLKT (n=1,326) or a LTA (n=4,283) between 3/1/02-12/31/09. Inverse Probability of Treatment Weighted (IPTW) - SLKT and LTA survival curves, along with the 5-year area under the survival curve were computed by dialysis status at transplant. The difference in the area under the curve represents the average additional survival time gained via SLKT over LTA. RESULTS: For @entity1 not on dialysis, SLKT resulted in a significant 3.7 month gain in 5-year mean post-transplant survival time. The decrease in mortality rate differs significantly by KDRI, and an estimated 76% of SLKT recipients received a kidney with KDRI sufficiently low for mortality. The mortality decrease for SLKT was concentrated in the first year post-transplant. The difference between @entity27973 and LTA 5-year mean post-transplant survival time was 1.4 months and non-significant for @entity1 not on dialysis. CONCLUSION: The propensity score-adjusted survival among SLKT and LTA recipients was similar for those who were dialysis at LT. Although statistically significant, the survival advantage of SLKT over LTA was of marginal clinical significance among @entity1 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 @entity8 . This article is protected by copyright. All rights reserved.
