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Publications

Journal Article Ahead of print

PubMed: 42962719 DOI: 10.1016/j.aohep.2026.102479

Long-Term Outcomes and Trends in Simultaneous Liver-Kidney Transplantation: A Multicenter Cohort Study.

Ann Hepatol

Authors: Jorge Carlos Martínez Morales, Valeria Descalzi, Elodie Bomfim Hyppolito, Adriana Varón, Alina Zerega, Pedro Marín-Castro, Graciela E Castro Narro, Josefina Pagés, Ignacio Roca, Adrián Gadano, Carlos Benítez, Bertha E Cárdenas Ramírez, Romina Rey, Álvaro Urzúa, Julia Brutti, Fernanda M Farage Osório, Paulo Lisboa Bittencourt, María L Reyes Toso, José Huygens Parente-García, Gilberto Mejía, Wellington Andraus, Manuel Mendizabal, Fernando Cairo, Renato Palma-Fernández, Melisa Dirchwolf, Mario Vilatobá, Mercedes Rodriguez Gazari, Diego Arufe, Gabriel Aballay, Rita de Cássia Martins Alves da Silva, Diego H Giunta, Angelo A Mattos, Sebastián Marciano

Affiliations

  • Liver and Hepatology Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Liver Transplant and Hepatology Unit, Fundación Favaloro, Buenos Aires, Argentina.
  • Walter Cantídio University Hospital, Federal University of Ceará, Fortaleza, Ceará, Brazil.
  • Hepatology Department, La Cardio - Fundación Cardio Infantil, Bogotá, Colombia.
  • Liver Transplant Unit, Sanatorio Allende, Córdoba, Argentina.
  • Liver and Digestive System Organ Transplant Unit, Hospital das Clínicas, São Paulo, Brazil.
  • Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
  • Hepatology and Transplant Unit, Hospital Universitario Austral, Pilar, Buenos Aires Province, Argentina.
  • Liver and Hepatology Transplant Unit, Hospital de Alta Complejidad "El Cruce", Florencio Varela, Buenos Aires Province, Argentina.
  • Liver and Hepatology Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  • Liver Transplant Hepatology, Instituto de Trasplante, Hospital Clínico UC-Christus, Santiago de Chile, Chile.
  • Liver Transplant Service, Hospital Nacional "Guillermo Almenara", Lima, Perú.
  • Bi-Institutional Liver Transplant Unit, National Liver Transplant Program, Montevideo, Uruguay.
  • Gastroenterology Section and Transplant Unit, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile.
  • Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina.
  • Liver Transplant Unit, Hospital das Clínicas da Universidade Federal de Minas Gerais, Minas Gerais, Brazil.
  • Gastroenterology and Hepatology Unit, Hospital Português da Bahia and Bahiana School of Medicine and Public Health, Salvador, Brazil.
  • Transplant Service, La Cardio, Fundación Cardio Infantil, Bogotá, Colombia.
  • Gastroenterology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
  • Liver Unit, Hospital Privado de Rosario, Rosario, Argentina.
  • Transplant Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
  • Liver and Hepatology Transplant Unit, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
  • Liver and Hepatology Transplant Unit, Sanatorio Sagrado Corazón, Buenos Aires, Argentina.
  • Hepatology and Liver Transplantation Unit, Institute of Transplantation and High Complexity Care, Buenos Aires, Argentina.
  • Liver Transplant Unit, Hospital de Base, São José do Rio Preto, São Paulo, Brazil.
  • University of Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Centre for Pharmacoepidemiology, Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
  • Full Professor of the Postgraduate Course in Hepatology at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.

Abstract

INTRODUCTION AND OBJECTIVES

Long-term outcomes after simultaneous liver-kidney transplantation (SLKT) are incompletely characterized. We aimed to estimate overall survival, survival with functioning grafts, kidney graft function over time, and temporal trends in SLKT practice.

PATIENTS AND METHODS

Retrospective multicenter cohort of adults undergoing SLKT between 2003 and 2025 across 21 transplant centers in 7 Latin American countries. Overall survival and survival with functioning grafts were estimated up to 10 years after transplantation. Outcomes, recipient and donor characteristics were described across transplant eras.

RESULTS

Among 305 SLKT recipients, cirrhosis was the main liver indication (67.9%), whereas chronic kidney disease was the main renal indication (93.1%), most commonly due to polycystic kidney disease. Recipient profiles evolved over time toward greater metabolic burden, with more diabetes and MASLD, and increasing use of MELD exceptions - primarily for hepatocellular carcinoma - compared with earlier transplant eras. Overall survival was 78.5% at 1 year and 57.3% at 10 years, with 1-year survival exceeding 90% in 2022-2025; survival with functioning grafts was 77.4% and 50.9%, respectively. Early mortality predominated: 64% of deaths occurred in the first year, mainly due to bacterial infections (39%). Median eGFR among survivors remained in the mid-60s through 10 years.

CONCLUSIONS

SLKT achieved acceptable long-term patient, graft, and kidney function outcomes, with improved 1-year survival in recent eras. Early mortality remained concentrated in the first year and was often infection-related, highlighting an important target for post-transplant care as recipient metabolic complexity increases. These multicenter data provide long-term benchmarks to inform counseling and program planning amid an evolving metabolic burden.

MeSH

Liver Diseases, Kidney Diseases, Liver Transplantation, Mortality, Cohort Studies, Kidney, Liver, Transplants, Kidney Transplantation, Transplantation, Infections