Simultaneous Liver Kidney Transplantation in the Era of Machine Perfusion: To Pump or Not to Pump?

Introduction:Simultaneous liver kidney transplantation (SLK) is utilized as a treatment for patients with renal dysfunction undergoing liver transplantation.Liver normothermic machine perfusion (NMP) has been shown to improve outcomes and expand the donor pool.The aim of this analysis is to compare patients undergoing SLK with and without the use of Liver NMP.Methods:Patients undergoing SLK from October 2012 to February 2024 were analyzed.Liver allografts were perfused with NMP via OrganOx and all kidney allografts underwent HMP.We compared donor/recipient characteristics, and 30-day postoperative outcomes between those undergoing SLK with and without NMP.The primary outcome included mortality and secondary outcomes included ischemic cholangiopathy, liver early allograft dysfunction (EAD) and renal delayed graft function (DGF).Results:A total of 27 patients undergoing SLK were identified, 14 patients without NMP and 13 patients with NMP.The median recipient age was 61 and the median MELD was 29.The median creatinine was 3.75 and 74% of patients were on dialysis prior to transplantation.The median donor age was higher in patients undergoing NMP (41 vs. 27, p = 0.003).81% of allografts were from donors after circulatory death (DCD), while 19% were brain dead donors (DBD).Livers were maintained on NMP for a median of 590 minutes and liver cold ischemic time (CIT) was higher in those patients undergoing NMP (357 vs. 298 minutes, p = 0.006).The median kidney CIT and was higher in the NMP cohort (1200 vs 473 minutes, p < 0.001).There was no difference in mortality (7.1% vs. 7.7%, p = 0.957).Liver EAD trended higher in patients undergoing SLK without NMP (7.1% vs 0%, p = 0.326).The overall rate of ischemic cholangiopathy was 15% and trended lower in those patients undergoing NMP (7.7% vs 21%, p = 0.315).There was no difference in renal DGF between the two groups (71% vs. 69%, p = 0.901).Conclusions:Simultaneous liver kidney transplantation with liver NMP and kidney HMP is safe with excellent liver and renal outcomes compared to SLK without NMP.