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Indications for combined liver and kidney transplantation: propositions after a 23‐yr experience
Author(s) -
Ruiz Richard,
Jennings Linda W.,
Kim Peter,
Tomiyama Koji,
Chinnakotla Srinath,
Fischbach Bernard V.,
Goldstein Robert M.,
Levy Marlon F.,
McKenna Greg J.,
Melton Larry B.,
Onaca Nicholas,
Randall Henry B.,
Sanchez Edmund Q.,
Susskind Brian M.,
Klintmalm Goran B.
Publication year - 2010
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2009.01180.x
Subject(s) - medicine , liver transplantation , renal function , urology , population , kidney , concomitant , transplantation , liver disease , kidney transplantation , hemodialysis , surgery , gastroenterology , environmental health
Ruiz R, Jennings LW, Kim P, Tomiyama K, Chinnakotla S, Fischbach BV, Goldstein RM, Levy MF, McKenna GJ, Melton LB, Onaca N, Randall HB, Sanchez EQ, Susskind BM, Klintmalm GB. Indications for combined liver and kidney transplantation: propositions after a 23‐yr experience.
Clin Transplant 2010: 24: 807–811. © 2009 John Wiley & Sons A/S. Abstract: The frequency of combined liver and kidney transplants (CLKT) persists despite the pronounced scarcity of organs. In this review, we sought to ascertain any factors that would reduce the use of these limited commodities. Seventy‐five adult CLKT were performed over a 23‐yr period at our center, 29 (39%) of which occurred during the Model for End‐stage Liver Disease (MELD) era. Overall, patient survival rates were 82%, 73%, and 62% at one, three, and five yr, respectively. There was no difference in patient survival based either on pre‐transplant hemodialysis status or by glomerular filtration rate (GFR) at the time of transplant. Patients undergoing a second CLKT or a liver retransplantation at the time of CLKT had a survival rate of 30% at three months. In the MELD era, patient survival was unchanged (p = NS) despite an older recipient population (p = 0.0029) and a greater number of hepatitis C patients (p = 0.0428). In summary, patients requiring liver retransplantation with concomitant renal failure should be denied CLKT. Renal allografts may also be spared by implementing strict criteria for renal organ allocation (GFR < 30 mL/min at the time of evaluation) and considering the elimination of preemptive kidney transplantation in CLKT.