title: Current indications for combined liver and kidney transplantation in adults.
abstract: A significant number of patients awaiting liver transplantation have associated renal failure. Combined Liver and Kidney Transplantation (CLKT) is increasingly offered especially since the introduction of Model for End-Stage Liver Disease (MELD). Decision to perform CLKT is straightforward when both organs suffer end-stage failure. However, the indications for CLKT are not well defined and there is controversy concerning some. We reviewed available data on PUBMED, United Network for Organ Sharing (UNOS), Organ Procurement Transplantation Network (OPTN), European Society for Organ Transplantation (ESOT) and discuss all current indications for CLKT.
  
  
  CONCLUSIONS
  Overall long-term outcome following CLKT is acceptable. There is an urgent need to further refine our ability to identify the cases with reversible renal injury in the setting of end-stage liver disease to avoid unnecessary CLKT. Liver protects the kidney from disease recurrence and allograft loss in metabolic diseases. However, the use of liver allograft for immunological protection of kidneys in highly sensitised patients with positive cross-match and previously failed renal transplants is still experimental.
authors.affiliation: King's College London School of Medicine at King's College Hospital, Institute of Liver Studies, Denmark Hill, Camberwell, SE5 9RS London, UK.
authors.forename: Srinivas P
authors.initials: SP
authors.lastname: Chava
authors.forename: Balbir
authors.initials: B
authors.lastname: Singh
authors.forename: Muhammad B
authors.initials: MB
authors.lastname: Zaman
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
mesh_terms: D000328:Adult; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends*; D016031:Liver Transplantation / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends*