title: Evaluation of native kidney recovery after simultaneous liver-kidney transplantation.
abstract: BACKGROUND
  Debate continues about which liver transplantation candidates with impaired renal function should undergo liver transplant alone versus simultaneous liver-kidney transplantation (SLK). Identifying predictors of native kidney function recovery after SLK requires an accurate measure of the relative function of all three kidneys in patients with SLK.
  
  
  METHODS
  The distance of a transplanted kidney from the renal scan camera can be substantially different from that of native kidneys. We developed a technique to correct attenuation of counts of all three kidneys based on their depth.
  
  
  RESULTS
  In our series of 13 SLK recipients, attenuation correction increased the measured renal function of native kidneys by up to 40%, demonstrating the importance of this procedure for accurately measuring kidney function. Eight patients met the United Network for Organ Sharing (UNOS)-proposed criteria for receiving a SLK, but four of these still had significant native kidney function (>40% of total function) after transplant. Five patients did not meet the UNOS-proposed criteria for SLK, yet only one of these had native kidney function recovery.
  
  
  CONCLUSIONS
  The criteria proposed by UNOS to determine that SLK is indicated, and thus that native kidney recovery is not expected, are not always accurate. Further study of factors associated with native kidney recovery after SLK is required.
authors.affiliation: Department of Medicine, Boston University Medical Center, Boston, MA, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Francis
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Palmer
authors.forename: Kevin
authors.initials: K
authors.lastname: Donohoe
authors.forename: Michael
authors.initials: M
authors.lastname: Curry
authors.forename: Scott R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Seth J
authors.initials: SJ
authors.lastname: Karp
authors.forename: Amy R
authors.initials: AR
authors.lastname: Evenson
authors.forename: Martha
authors.initials: M
authors.lastname: Pavlakis
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D018579:Patient Selection; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals