Simultaneous liver-kidney transplant for combined renal and hepatic end-stage disease.
BACKGROUND
After the first combined liver-kidney transplantation (CLKT) reported by Margreiter in 1984, it became clear that renal failure was no longer an absolute contraindication.


OBJECTIVE
Our goal was to assess our results with combined liver-kidney transplant. Among 875 liver transplants performed between May 1986 and October 2002, there were 17 cases (1.96%) of combined liver-kidney transplant.


RESULTS
With a mean follow-up of 42.2+/-29 months (range, 1-90), six patients had died (mortality: 37.5%). There were four (25%) operative in-hospital deaths, and two late mortality cases (beyond the month 6 after hospital discharge). The causes were sepsis (four cases, three postoperative and one in later follow-up), refractory heart failure (one postoperative), and recurrent liver disease (HCV-induced severe recurrence) during follow-up one). Actuarial survival (calculated for those who survived the postoperative period) was 80%, 71%, and 60% at 12, 36, and 60 months. Actuarial mean survival time was 60 months (95%IC:47-78). Neither the sex, the UNOS status, the etiology of liver disease, the etiology of renal failure, the type of hepatectomy (piggy back vs others) or the type of immunosuppression (P=.83) were related to long-term survival according to the log-rank test. A control group of 48 patients was constructed with subjects who underwent liver transplantation immediately before or after the combined transplant. A total (two cases after the CLKT and one case prior to). There were no differences in survival.


CONCLUSIONS
Combined liver-kidney transplant represents a proper therapeutic option for patients with simultaneously failing organs based on long- and short-term outcomes.
Moreno-Gonzalez
E
E
Service of General, Digestive and Abdominal Organs Transplantation, University Hospital 12 de Octubre, Madrid, Spain.
Meneu-Diaz
J C
JC
García
García
G
Jimenez Romero
C
C
Loinaz Segurola
C
C
Gomez Sanz
R
R
Abradelo
M
M
Perez Cerda
F
F
Moreno Elola-Olaso
A
A
Marin
L M
LM
Jimenez de los Galanes
S
S
Calvo Pulido
J
J
D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome