title: 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.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Multiorgan transplantation service in a large university medical center.
  
  
  METHODS
  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.
  
  
  METHODS
  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.affiliation: Department of Surgery, Dumont-UCLA Transplant Center,University of California, Los Angeles, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ruiz
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kunitake
authors.forename: Alan H
authors.initials: AH
authors.lastname: Wilkinson
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Rafik M
authors.initials: RM
authors.lastname: Ghobrial
authors.forename: Hasan
authors.initials: H
authors.lastname: Yersiz
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006530:Hepatorenal Syndrome / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome