Simultaneous lung-kidney transplantation is rarely performed. Contemporary national practice trends and outcomes are unclear.
From the United Network for Organ Sharing database, we identified 108 lung-kidney transplant recipients (2005-2022). They were compared with isolated lung recipients with pre-transplant dialysis or estimated glomerular filtration rate (eGFR) ≤ 30 mL/min/1.73m (n=372) and isolated non-dialysis-dependent lung recipients with 30<eGFR<50 mL/min/1.73m (n=1,416), respectively. Lung-kidney recipients were also compared to recipients of the contralateral kidney from the same donors (n=90).
Lung-kidney transplant was performed by 36 centers, with increasing annual volume (1 in 2005, 16 in 2022, p<0.01). Forty percent (44/108) of lung-kidney recipients received pre-transplant dialysis, and among those without pre-transplant dialysis, median eGFR was 30.7 mL/min/1.73 m. Lung-kidney recipients had improved survival than isolated lung recipients with eGFR ≤ 30 or pre-transplant dialysis (adjusted hazard ratio [aHR] 0.59, 95% CI 0.38-0.92). However, no survival benefit was observed when lung-kidney recipients were compared to isolated lung recipients with 30<eGFR<50 and no pre-transplant dialysis (aHR 0.88, 95% CI 0.55-1.41). When compared to isolated kidney recipients using the contralateral kidney from the same donors, lung-kidney recipients had a higher risk of kidney allograft loss (aHR 3.27, 95% CI 1.22-8.78), a difference largely accounted for by patient death with a functioning kidney allograft.
Recipients of lung-kidney transplantation had improved survival when compared to isolated lung recipients with eGFR≤30 or pre-transplant dialysis. However, lung-kidney recipients had a higher rate of kidney allograft loss than recipients of the contralateral kidney allograft from the same donors.

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