Background: Since the United Network for Organ Sharing (UNOS) implemented MELD system to determine liver graft allocation in 2002, the number of simultaneous liver-kidney transplants (SLK) has increased. Previous studies have shown that patient survival in post-MELD era is improved in those with long-term dialysis (>3months.), compared to patient survival in liver transplant alone (LTA). Our study is aimed to compare survival outcomes among SLK after MELD era according to their specific diagnosis, HCV vs non-HCV.

Methods: In this IRB-approved retrospective study, clinical data review was performed in all patients who underwent combined liver-kidney transplants at Johns Hopkins Hospital from January 31, 1995 to October 31, 2012. Combined but non-simultaneous transplants, in which liver and kidney transplants took place more than 24-hour apart, were excluded. All cases with prior LTA, kidney transplant alone (KTA) or SLK were also excluded. Differences in patient demographics and characteristics among two groups were compared using independent-samples t-test. Survival analysis and the distributions were calculated using Kaplan-Meier method and Mantel-Cox log-rank test.

Results: Out of total 43 (48) CLKs, 30 (31) SLK cases (24 (25) post-MELD and 6 pre-MELD), were included. Proportions of age, gender, ethnicity, pre-transplant MELD score; pre-transplant renal replacement therapy (RRT) requirement, hypertension, diabetes mellitus and follow-up period were similar in two groups. Median follow up period was 30 months. Both overall and kidney-graft survival in pre-MELD era were 50%, but they were 91.7% in post-MELD era (p=0.02). However, when compared to the diagnosis, there was no statistical significance between overall and kidney-graft survival among 9 (10) HCV and 15 non-HCV subgroups in post-MELD patients (p=0.670 and p=0.403).

Conclusion: Literature suggests lower risk of liver graft loss in SLK compared to LTA, but not much information is available regarding the specific diagnosis of the underlying liver disease, HCV vs non-HCV. In our study, we have again demonstrated statistically significant difference in overall and kidney graft survival between the post-MELD era and the pre-MELD era. Subgroup analysis of this group showed no statistically significant difference in overall and kidney-graft survival, when compared to their specific diagnosis of HCV. This observation needs to be further studied and verified in larger cohort of patients to fully identify the impact of Hepatitis C infection in this group of patients since it can affect both liver and kidney grafts, post transplantation.