Acute or chronic liver failure is commonly associated with some degree of renal dysfunction. In selected patients with an irreversible renal failure a combined kidney and liver transplantation may be indicated. Simultaneous combined liver and kidney transplantation (SCLKTx) have been proposed as effective treatment for patients with chronic diseases of both organs. Among the 669 liver transplants (LTx) performed in our Center between January 1987 and May 2010, there were 16 SCLKTx (2.4%). Most common indications for LTx were hyperoxaluria type 1, liver cyrrhosis, polycystic liver disease, cystinosis and congenital biliary fibrosis. The kidney transplantation (KLTx) indications were end-stage renal disease of different causes, hyperoxaluria type 1, polycystic kidney disease and cystinosis. Four patients died (25%). Of these, two died during early post-transplant hospital stay, whereas two late deaths occurred after the month 12. The death causes were sepsis (n = 2), refractory heart failure (n = 1) and HCV-induced severe recurrence (n = 1). Overall, the most important encountered complications as graft lost were liver and kidney irreversible rejection. Patient survival at 1, 3 and 5 years was 77%, 67% and 67%, respectively. At the same time-points, liver graft survival was 77%, 70% and 70%, respectively, while kidney graft survival was 77%, 65% and 56%, respectively. Liver and kidney graft survival of the metabolic group (n = 6) appeared to be better than non-metabolic group (n = 10), with a difference statistically significant (80% vs. 62%; p < 0.04). SCLKTx represents the treatment of choice in patients with end-stage liver disease and irreversible renal failure. In our Center the results are similar to isolated liver transplantation, with a lower number of acute rejection episodes for kidney grafts. In conclusion, liver allograft seems to immunologically protect the transplanted kidney by unknown mechanisms, especially in liver–based metabolic diseases affecting the kidney.
Combined liver and kidney transplantation: a single center experience.
SANTORI, GREGORIO;VALENTE, UMBERTO
2011-01-01
Abstract
Acute or chronic liver failure is commonly associated with some degree of renal dysfunction. In selected patients with an irreversible renal failure a combined kidney and liver transplantation may be indicated. Simultaneous combined liver and kidney transplantation (SCLKTx) have been proposed as effective treatment for patients with chronic diseases of both organs. Among the 669 liver transplants (LTx) performed in our Center between January 1987 and May 2010, there were 16 SCLKTx (2.4%). Most common indications for LTx were hyperoxaluria type 1, liver cyrrhosis, polycystic liver disease, cystinosis and congenital biliary fibrosis. The kidney transplantation (KLTx) indications were end-stage renal disease of different causes, hyperoxaluria type 1, polycystic kidney disease and cystinosis. Four patients died (25%). Of these, two died during early post-transplant hospital stay, whereas two late deaths occurred after the month 12. The death causes were sepsis (n = 2), refractory heart failure (n = 1) and HCV-induced severe recurrence (n = 1). Overall, the most important encountered complications as graft lost were liver and kidney irreversible rejection. Patient survival at 1, 3 and 5 years was 77%, 67% and 67%, respectively. At the same time-points, liver graft survival was 77%, 70% and 70%, respectively, while kidney graft survival was 77%, 65% and 56%, respectively. Liver and kidney graft survival of the metabolic group (n = 6) appeared to be better than non-metabolic group (n = 10), with a difference statistically significant (80% vs. 62%; p < 0.04). SCLKTx represents the treatment of choice in patients with end-stage liver disease and irreversible renal failure. In our Center the results are similar to isolated liver transplantation, with a lower number of acute rejection episodes for kidney grafts. In conclusion, liver allograft seems to immunologically protect the transplanted kidney by unknown mechanisms, especially in liver–based metabolic diseases affecting the kidney.
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