Disparity in utilization of combined kidney-liver transplantation in the United States.
BACKGROUND
Orthotopic liver transplantation (OLT) is performed as a definitive treatment of acute and chronic liver failure. The prevalence of acute and chronic kidney diseases is substantially higher in this population secondary to diverse etiologies. Combined kidney-liver transplantation (CKLT) is widely performed in some centers, even though there are no definitive studies which support or contradict this practice.


METHODS
We comprehensively reviewed OLT as well as CKLT data from US transplant centers provided by United Network of Organ Sharing (UNOS).


RESULTS
The incidence of CKLT as a percentage of total OLTs performed has been increasing, especially in the post-MELD era (2002 and after). Moreover, there is a great disparity among centers in regard to percentage of CKLTs to total OLTs.


CONCLUSIONS
We conclude that there is much difference of opinion among US transplant centers as to indications for CKLT. A more scientific approach to this problem including studies to assess the role of kidney biopsy in determining renal outcome after OLT is needed.
Mehta
S D
SD
Departments of Medicine, Hines VA Hospital, Hines, IL and Loyola University Medical Center, Maywood, IL, USA.
Leehey
D J
DJ
D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D017093:Liver Failure / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D009017:Morbidity; D014481:United States / Q000453:epidemiology