The impact of recipient age on the post-liver transplant prognosis of simultaneous liver and kidney transplantation

Abstract

Background & Aims

Simultaneous liver and kidney transplant (SLKT) can be a life-saving procedure for those with liver failure and concomitant kidney disease. This study evaluates the post-transplant outcomes and prognosis based on the recipients’ age using the UNOS-STAR database.

Methods

Using the UNOS-STAR registry (2005–2019), patients who underwent SLKT were selected. They were stratified by the recipients’ each age cohort. Those under the age of 18, retransplantation, and with prior liver transplantation were excluded. Iterative Cox regression was performed on multiple mortality endpoints to assess the prognostic effects.

Results

From 5748 SLKT patients, there were five age groups of recipients: ages 18–39 (n = 371), quadragenarian (n = 759), quinquagenarian (n = 2112), sexagenarian (n = 2202), and septuagenarian (n = 183). The median follow-up time was 3.03 years (25–75 % IQR: 1.02–7.00). Assessing the primary endpoints, the sexagenarian recipients had a significantly lower incidence of graft failure compared to the controls (aHR 0.36, 95 % CI 0.19–0.68, p = 0.002). The septuagenarian recipients experienced a higher incidence of all-cause mortality compared to the controls (aHR 2.08, 95 % CI 1.34–3.21, p = 0.001). However, the quadragenarian and quinquagenarian recipients did not have significant differences in all-cause mortality and graft failure. Evaluating the end-organ outcomes, there were no significant differences obtained among the recipients with various age cohorts.

Conclusion

This study demonstrates the advanced age of transplant recipients with SLKT was associated with increased all-cause mortality. Therefore, certain groups of SLKT recipients had differential impacts based on the chronicle ages.