We aimed to understand the contemporary changes in the characteristics and the determinants of outcomes among simultaneous liver-kidney transplantation (SLKT) recipients at 6 liver transplantation centers in the United States. We retrospectively enrolled SLKT recipients between 2002 and 2017 in the US Multicenter SLKT Consortium. We analyzed time-related trends in recipient characteristics and outcomes with linear regression and nonparametric methods. Clustered Cox regression determined the factors associated with 1-year and overall survival. We enrolled 572 patients. We found significant changes in the clinical characteristics of SLKT recipients: as compared with 2002, recipients in 2017 were older (59 versus 52 years; P < 0.001) and more likely to have chronic kidney disease (71% versus 33%; P < 0.001). There was a marked improvement in 1-year survival during the study period: 89% in 2002 versus 96% in 2017 (P < 0.001). We found that the drivers of 1-year mortality were SLKT year, hemodialysis at listing, donor distance, and delayed kidney allograft function. The drivers of overall mortality were an indication of acute kidney dysfunction, body mass index, hypertension, creatinine at SLKT, ventilation at SLKT, and donor quality. In this contemporary cohort of SLKT recipients, we highlight changes in the clinical characteristics of recipients. Further, we identify the determinants of 1-year and overall survival to highlight the variables that require the greatest attention to optimize outcomes.

中文翻译：

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肝肾同步移植后的时间趋势和不断发展的结果：来自美国 SLKT 联盟的结果

我们旨在了解美国 6 个肝移植中心同步肝肾移植 (SLKT) 受者的特征和结果决定因素的当代变化。我们回顾性地招募了 2002 年至 2017 年间美国多中心 SLKT 联盟的 SLKT 接受者。我们使用线性回归和非参数方法分析了接受者特征和结果的时间相关趋势。聚类 Cox 回归确定了与 1 年和总生存相关的因素。我们招募了 572 名患者。我们发现 SLKT 接受者的临床特征发生了显着变化：与 2002 年相比，2017 年的接受者年龄更大（59 岁 vs 52 岁；P  < 0.001）并且更可能患有慢性肾病（71% vs 33%；P < 0.001)。在研究期间，1 年生存率有显着改善：2002 年为 89%，2017 年为 96%（P  < 0.001）。我们发现 1 年死亡率的驱动因素是 SLKT 年、挂牌时血液透析、供体距离和肾同种异体移植功能延迟。总体死亡率的驱动因素是急性肾功能障碍、体重指数、高血压、SLKT 肌酐、SLKT 通气和供体质量的指标。在这个当代的 SLKT 接受者队列中，我们强调了接受者临床特征的变化。此外，我们确定了 1 年和总生存率的决定因素，以突出需要最大程度关注以优化结果的变量。