title: Analysis of kidney function and biopsy results in liver failure patients with renal dysfunction: a new look to combined liver kidney allocation in the post-MELD era.
abstract: BACKGROUND
  Renal dysfunction in the context of liver failure negatively impacts orthotopic liver transplantation (OLT) outcomes. Appropriate allocation of combined liver and kidney transplants (CLKT) is crucial with the current organ shortage and lack of standard selection criteria.
  
  
  METHODS
  We propose a practical workup algorithm for CLKT by using three variables: duration of renal insufficiency and glomerular filtration rate measured by the iodine-125 iothalamate (Glofil) test and renal biopsy findings. The study was divided into two phases. In the first phase, we retrospectively reviewed the clinical and laboratory database of all liver transplant patients (n=196) performed in our institution. In the second phase, we prospectively implemented the algorithm on 20 selected patients with liver failure and renal dysfunction (chronic kidney disease stage 3 and acute kidney injury) worked up for OLT.
  
  
  RESULTS
  Based on the workup algorithm, we recommended OLT for 12 patients and CLKT for eight patients. We were able to avoid CLKT for six patients without causing adverse renal outcomes among 11 patients transplanted by using this algorithm. The average 12-month renal outcomes of these transplanted patients seem to be favorable with the mean serum creatinine 1.3 mg/dL in OLT group and 1.1 mg/dL in CLKT group.
  
  
  CONCLUSIONS
  The workup algorithm, which primarily uses duration of renal failure, glofil measurement, and renal biopsy findings, offers a practical approach to this complicated decision-making process regarding appropriate allocation of organs for CLKT.
authors.affiliation: Dallas Nephrology Associates, Dallas, TX 75208, USA. tanrioverb@dneph.com
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mejia
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weinstein
authors.forename: Steven V
authors.initials: SV
authors.lastname: Foster
authors.forename: Reem
authors.initials: R
authors.lastname: Ghalib
authors.forename: Abdullah
authors.initials: A
authors.lastname: Mubarak
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D008107:Liver Diseases / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome