title: Combined liver and kidney transplantation: analysis of Padova experience.
abstract: OBJECTIVE
  The main indications for combined liver and kidney transplantation (CLKT) are as follows: (1) cirrhosis with renal damage dependent or not upon liver disease, (2) renal failure with dialysis and concomitant liver end-stage disease, (3) congenital diseases, and (4) enzymatic liver deficiency with concomitant renal failure. The aim of this study was to evaluate our results with CLKT both in adult and pediatric patients.
  
  
  METHODS
  From September 1995 to September 2006, 15 CLKT (2.8%) among 541 liver transplantations included 4 pediatric patients (27%). The main indications for CLKT were hepatitis C virus (HCV) and polycystic diseases in adult patients, and primary hyperoxaluria in pediatric patients.
  
  
  RESULTS
  The double transplantation was performed from the same donor in all cases. All adult patients received whole liver grafts, whereas 3 split transplants and 1 whole liver graft were transplanted in the pediatric patients. Median liver and kidney cold ischemia times were 468 and 675 minutes, respectively. After a median follow-up of 36 months (range, 1-125), the overall survival rate was 80%. Five-year patient and graft survival rates were 100% for adult CLKT, whereas they were 50% for pediatric patients. We observed only 2 cases (18%) of delayed renal function, requiring temporary hemodialysis with progressive graft improvement. There was only 1 case of kidney retransplantation due to early graft nonfunction in a pediatric patient.
  
  
  CONCLUSIONS
  Although CLKT is related to major surgical risks, results after transplantation are satisfactory with an evident immunological advantage.
authors: Department of Surgical and Gastroenterological Science, University of Padova, Padova, Italy. zanus@unipd.it
authors: G
authors: G
authors: Zanus
authors: A
authors: A
authors: Carraro
authors: A
authors: A
authors: Vitale
authors: P
authors: P
authors: Boccagni
authors: A
authors: A
authors: Brolese
authors: D
authors: D
authors: Neri
authors: N
authors: N
authors: Srsen
authors: E
authors: E
authors: Gringeri
authors: M
authors: M
authors: Valmasoni
authors: F
authors: F
authors: D'Amico
authors: F A
authors: FA
authors: Ciarleglio
authors: P
authors: P
authors: Violi
authors: P
authors: P
authors: Bonsignore
authors: A
authors: A
authors: Pauletto
authors: D
authors: D
authors: Bassi
authors: F
authors: F
authors: D'Amico
authors: P
authors: P
authors: Burra
authors: A
authors: A
authors: Masier
authors: P
authors: P
authors: Rigotti
authors: L
authors: L
authors: Furian
authors: M
authors: M
authors: Polacco
authors: D F
authors: DF
authors: D'Amico
authors: U
authors: U
authors: Cillo
mesh_terms: D049669:History, 16th Century; D006801:Humans; D007558:Italy; D007674:Kidney Diseases / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome