Simultaneous liver–kidney transplantation from donation after cardiac death donors: an updated perspective

Outcomes of both donation after cardiac death (DCD) liver and kidney transplants are improving. Experience in simultaneous liver–kidney transplant (SLK) using DCD donors, however, remains limited. In an updated cohort (2010-2018), outcomes of 30 DCD SLK and 131 donation after brain death (DBD) SLK from Mayo Clinic Arizona and Mayo Clinic Minnesota were reviewed. The Model for End-Stage Liver Disease score was lower in the DCD SLK group (23 vs 29, P =.01). Kidney delayed graft function (DGF) rates were similar between the 2 groups (P =.11), although the duration of DGF was longer for DCD SLK recipients (20 vs 4 days, P =.01). Liver allograft (93.3% vs 93.1%, P =.29), kidney allograft (93.3% vs 93.1%, P =.91), and patient (96.7% vs 95.4%, P =.70) 1-year survival rates were similar. At 1 year, there were no differences in the estimated glomerular filtration rate (57.7 ± 18.2 vs 56.3 ± 17.7, P =.75) or progression of fibrosis (ci) on protocol kidney biopsy (P =.67). A higher incidence of biliary complications was observed in the DCD SLK group, with ischemic cholangiopathy being the most common (10.0% vs 0.0%, P =.03). The majority of biliary complications resolved with endoscopic management. With appropriate selection, DCD SLK recipients can have results equivalent to those of DBD SLK recipients.