title: Simultaneous combined liver and kidney transplantation: a single center experience.
abstract: Renal dysfunction is common in patients awaiting liver transplantation (LT) and affects outcome following LT. Combined liver and kidney transplantation (CLKT) has been proposed as effective treatment for patients with chronic diseases of both organs, some with hepatorenal syndrome and for liver-based metabolic diseases affecting kidney. This study is undertaken to analyze results of CLKT at a single center. Of 2690 LTs performed between 1992 and 2007, there were 39 CLKTs; most common indications were metabolic, cirrhosis and polycystic disease. With follow-up of up to 170 months, 11 died (overall survival 71.8%); one-, five-, and 10-yr patient and liver graft survival is 77%, 73.7%, and 73.7%, respectively, and kidney graft survival is 77%, 70%, and 70%, respectively. Survival among metabolic group (78.6%) appeared to be better than non-metabolic group (68%); however, this difference was not significant (p = 0.39). Fifteen surviving patients (53.6%) have mild/moderate renal impairment (creatinine > or = 125 micromol/L). None has severe renal failure (serum creatinine > or = 250 micromol/L) or end-stage renal disease requiring hemodialysis. CLKT has good results in selected groups of patients. It provides protection to kidney allograft in liver-based metabolic diseases affecting kidney. The rate of acute rejection episodes of kidney is low. Significant proportion develops long-term mild/moderate renal dysfunction. Careful attention to immunosuppression to minimize nephrotoxicity may help.
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, 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: Arie
authors.initials: A
authors.lastname: Stangou
authors.forename: Narendra
authors.initials: N
authors.lastname: Battula
authors.forename: Matthew
authors.initials: M
authors.lastname: Bowles
authors.forename: John
authors.initials: J
authors.lastname: O'Grady
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000401:mortality*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents