Long-term analysis of combined liver and kidney transplantation at a single center.

Abstract

OBJECTIVE:

To analyze use of combined liver and kidney transplantation (CLKT) for patients with chronic primary diseases of both organs and for patients with hepatorenal syndrome.

DESIGN:

Retrospective case series.

SETTING:

Multiorgan transplantation service in a large university medical center.

PATIENTS:

A total of 98 patients underwent 99 CLKTs during a 16-year period; 76 had primary renal diseases, and 22 had hepatorenal syndrome. Patients receiving isolated liver and kidney transplants were analyzed for comparison.

MAIN OUTCOME MEASURES:

Patient and graft survival, rejection rates, and need for hemodialysis before and after transplantation.

RESULTS:

Overall patient survival was 76%, 72%, and 70% at 1, 3, and 5 years, respectively; liver graft survival was 70%, 65%, and 65%; and kidney graft survival was 76%, 72%, and 70%. No risk factors analyzed for recipients or donors were associated significantly with early posttransplantation mortality or graft loss. In 28 patients who received monoclonal antibody induction therapy with interleukin 2 blockers, there were significantly fewer episodes of acute liver rejection. For patients with hepatorenal syndrome, CLKT did not confer a survival advantage over liver-only transplantation (1-year patient survival was 72% vs 66%; P = .88). The 1-year acute kidney rejection rate in the adult CLKT group was 14% vs 23% in a 5-year cadaveric renal transplantation cohort (P<.01).

CONCLUSIONS:

First, CLKT is indicated in patients with dual organ disease and achieves excellent results. Second, CLKT for hepatorenal syndrome is indicated in patients receiving hemodialysis for longer than 8 weeks and confers advantages in patient survival and use of hospital resources. Third, the liver is immunoprotective for the kidney.

• Authors: Richard Ruiz, Hiroko Kunitake, Alan H Wilkinson, Gabriel M Danovitch, Douglas G Farmer, Rafik M Ghobrial, Hasan Yersiz, Jonathan R Hiatt, Ronald W Busuttil
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 141 Issue 8 Pg. 735-41; discussion 741-2 (Aug 2006) ISSN: 0004-0010 [Print] United States
• PMID: 16924080 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Graft Rejection (epidemiology)
• Graft Survival
• Hepatorenal Syndrome (mortality, surgery)
• Humans
• Incidence
• Infant
• Kidney Transplantation (methods, mortality)
• Liver Transplantation (methods, mortality)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Survival Rate (trends)
• Time Factors
• Treatment Outcome