Kidney allograft outcomes in combined kidney with other solid organ transplantation

Table 1 Summary of kidney allograft outcomes in combined solid organ transplantation based on major published studies

Type of combined transplant	Delayed graft function	Acute rejection	Kidney graft failure/survival	Patient survival
SLK	(1) 39% of cases (Lunsford et al[11]); (2) Higher with high MELD, vasopressor use, or poor hemodynamic status; and (3) Delayed kidney implantation (up to 48 hours) reduces DGF	Possible lower rejection rates vs KTA thought to be due to an immunomodulatory mechanism conferred by liver	(1) Renal allograft futility in 20.7% (death or dialysis by 3 months, Lunsford et al[11]); and (2) Early graft loss linked to hemodynamic instability and high MELD	Early mortality higher in high-MELD SLK recipients, but long-term survival similar to KTA once stabilized
SHKT	(1) 27%-37% of cases (Swanson et al[1], Grupper et al[16]); (2) Linked to pre-transplant mechanical circulatory support and RV pressure elevation; and (3) Delayed kidney implantation (up to 69 hours) can reduce risk	No significant difference vs KTA	5-year-graft survival 72% (vs 73% in KTA, Choudhury et al[9])	5-year patient survival lower (75% vs 84%) due to cardiac comorbidities (Choudhury et al[9])
SLKT	(1) Higher DGF risk than kidney-after-lung (3 vs 0 cases; Mesnard et al[31]); and (2) Often due to circulatory shock during lung transplant	Insufficient data on rejection rates	(1) > 3 times high hazard of kidney graft loss (HR = 3.27, P < 0.001, Chen et al[4]); and (2) Primarily from death with functioning graft	Overall survival lower than KTA due to lung-related mortality, not renal factors
SPK	(1) Lower DGF incidence vs KTA (Israni et al[41]); and (2) Improved ischemia times metabolic milieu from normoglycemia	No significant difference vs KTA	Superior long term graft year survival. 10-year survival 78% (vs 60%-65% for KTA, Reddy et al[36], Esmeijer et al[37])	Improved patient survival and reduced cardiovascular mortality (3.3% vs 19%, Lange et al[39])

SLK: Simultaneous liver-kidney; SHKT: Simultaneous heart and kidney transplantation; SLKT: Simultaneous lung and kidney transplant; SPK: Simultaneous pancreas-kidney; MELD: Model for end-stage liver disease; DGF: Delayed graft function; RV: Right ventricle; KTA: Kidney transplant alone; HR: Hazard ratio.