The clinical outcome of sequential liver-kidney transplantation

Background: It is rare for a patient to receive both liver and kidney transplant. In addition, there are not many studies on the outcome when the two organs are transplanted sequentially rather than simultaneously. So, we aimed to evaluate the outcomes of patients who underwent sequential liver-kidney transplantation (SLKT) and compare them with those who maintained dialysis. Methods: We first retrospectively analyzed 2,615 patients who received K T from 2000 to 2023 at Seoul St. Mary's Hospital. Among them, we found patients with a history of liver transplantation (LT) before KT and analyzed their graft survival. Patients who received simultaneously liver-kidney transplantation were excluded. To compare the outcome with SLKT group, we analyzed patients who maintained dialysis for end-stage renal disease after LT. Results: Out of 2,615 KT patients who received KT during the period from 2000 to 2023, a total of 11 patients received SLKT. Among them, five people received from the same living donor, five received LT from living donor and then KT from deceased donor, and only one received LT and KT from different living donors. The mean interval between LT and KT was 6.8 years. Only one patient experienced kidney graft failure, receiving KT in 2011 and starting dialysis in 2023, with a graft survival of 12 years. The other 10 patients all maintain kidney function with an average creatinine of 1.92 mg/dL without dialysis after KT, and the longest graft survival period is 13.1 years. During the same period, 28 patients maintained dialysis without KT after receiving LT. Five patients received transplantation from deceased donor and 23 patients received transplantation from a living donor. Among them, seven patients died, showing a mortality rate of 25% and the average duration of dialysis was 3.4 years. Conclusions: If the post-liver transplantation patient is on dialysis, actively considering KT will be better option for the patient's outcome.