TIMING MATTERS: SIMULTANEOUS VS DELAYED COMBINED LIVER-KIDNEY TRANSPLANTATION federicachimenti96@gmail.com

 

TIMING MATTERS: SIMULTANEOUS VS DELAYED COMBINED LIVER-KIDNEY TRANSPLANTATION

4

Italy

Poster Exhibition only

Combined liver-kidney transplant (CLKT) is a procedure used for patients with both end-stage liver disease and chronic kidney disease or prolonged acute kidney injury. There are two different type of CLKT: simultaneous kidney transplant (SKT) and delayed kidney transplant (DKT), the latter performed within 48–72 hours with hypothermic machine perfusion. The prognostic impact of transplant timing remains debated.

Retrospective analysis of CLKT performed at Niguarda Hospital (Milan) between 2009 and 2025. 38 patients were included: 21 SKT and 17 DKT. Patients receiving KT after 72h or those who died while on the waiting list were excluded. Endpoints were overall survival and graft survival. Descriptive statistics, Kaplan–Meier (KM) analysis, and Cox regression were performed. To minimize selection bias, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were applied. A Cox-based nomogram was developed to estimate 60-month survival using preoperative predictors.

OS at 5 years was 74% in SKT vs 93% in DKT. KM analysis after IPTW confirmed significant survival disadvantage for SLKT (log-rank p=0.038). In multivariable Cox regression, Child–Pugh class B/C (HR 3.44), higher Charlson comorbidity index (HR 1.27 per point), and SLKT strategy emerged as the main determinants of mortality. A nomogram based on Child–Pugh, Charlson and MELD-Na achieved good discrimination (C-index = 0.80) and allowed individualized prediction of 60-months survival.

SKT was associated with significantly worse survival. Comorbidity and liver function were the strongest predictors of outcome. The proposed nomogram provides a practical tool to stratify risk and may guide transplant timing and patient selection.