title: Results of combined and sequential liver-kidney transplantation.
abstract: Experience with combined liver-kidney transplantation (L-KTx) has increased, but controversy regarding this procedure continues because the indications are not clearly defined yet. Between 1984 and 2000, 38 patients underwent simultaneous L-KTx and 9 patients underwent sequential transplantation, receiving either a liver before a kidney or a kidney before a liver. Main indications for a simultaneous procedure were polycystic liver-kidney disease with cirrhosis and coincidental renal failure. The main indications for sequential procedure were cirrhosis caused by viral infection for the liver and glomerulonephritis for the kidneys. Outcomes in these patients were evaluated retrospectively. Regarding simultaneous transplantation, 28 (73.7%) long-term survivors were followed up for 0.7 to 12.5 years. Currently, 24 (63.2%) patients are alive with good liver function. Fourteen patients died; 10 patients died in the early postoperative phase because of septic complications, and most of them were cirrhotic with a poor preoperative clinical status. Currently, 2 of the surviving patients (8%) have returned to dialysis, 4 (17%) have reduced renal function, and 18 (75%) have good renal function. Five liver and 2 kidney retransplantations were performed during the follow-up. In cases of sequential grafting, patients undergoing kidney transplantation in the presence of a previously transplanted stable liver did better than those who underwent liver transplantation after kidney transplantation. When liver transplantation was performed early and electively before substantial worsening, combined L-KTx is a safe procedure offering excellent long-term palliation.
authors.affiliation: Klinik fuer Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany. Becker.Thomas@mh-hannover.de
authors.forename: Gülçin
authors.initials: G
authors.lastname: Demirci
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
authors.forename: Miguel
authors.initials: M
authors.lastname: Nyibata
authors.forename: Rainer
authors.initials: R
authors.lastname: Lueck
authors.forename: Hueseyin
authors.initials: H
authors.lastname: Bektas
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.forename: Günter
authors.initials: G
authors.lastname: Tusch
authors.forename: Christian
authors.initials: C
authors.lastname: Strassburg
authors.forename: Anke
authors.initials: A
authors.lastname: Schwarz
authors.forename: Juergen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Bjoern
authors.initials: B
authors.lastname: Nashan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D017093:Liver Failure / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis