O-1 SIMULTANEOUS LIVER-KIDNEY TRANSPLANTATION OUTCOMES IN LATIN AMERICA

No Simultaneous liver-kidney transplantation (SLKT) is increasingly performed worldwide. We aimed to evaluate the characteristics and outcomes of SLKT patients in Latin America. We conducted a multicenter, international retrospective cohort study of adult patients who underwent SLKT. Overall survival and survival with functional grafts (both liver and kidney) were estimated using the Kaplan-Meier method. 293 patients who underwent SLKT between 2003 and 2024 from Argentina, Brazil, Colombia, Chile, Mexico, Peru, and Uruguay were included. Patients had a median age of 56 (IQR: 47–61), and 63% were male. Primary indications for liver transplantation were decompensated cirrhosis (69%) and polycystic disease (19%). The most common etiologies of cirrhosis were viral (36%), alcohol-related (35%), and metabolic-associated steatotic liver disease (27%). Ninety-three percent of kidney indications were due to chronic kidney disease, primarily polycystic kidney disease (26%), diabetic nephropathy (25%), and hypertensive nephropathy (11%). Among patients transplanted for acute kidney injury, 75% had hepatorenal syndrome. Overall, 55% were on pre-transplant renal replacement therapy (RRT). Thirty-eight percent accessed transplantation with MELD exceptions. The median MELD-Na score was 24 (19-30), 25 (21-32) in those without supplementary MELD, and 20 (17-25) in those with supplementary MELD. Fourteen percent had a prior isolated transplant (kidney 50% and liver 50%. Twenty-five percent required RRT, and 18% underwent abdominal re-operation within the first post-transplant week. During long follow-up, 13% experienced major cardiovascular events, and 7% experienced oncological complications. Other recipient and donor characteristics are presented in the table. One-year overall survival was 77% (95% CI 72-82); at 5 years, it was 67% (95% CI 60-72); and at 10 years, it was 59% (95% CI 51-66). Survival with functional grafts at 1 year was 77% (95% CI 72-82); at 5 years, it was 65% (95% CI 58-70); and at 10 years, it was 54% (95% CI 46-62). For the first time, data from the region demonstrate that long-term patient survival following SLKT meets international standards.