title: Experience of combined liver-kidney transplantation for acute-on-chronic liver failure patients with renal dysfunction.
abstract: BACKGROUND
  The aim of this study was to evaluate the outcomes of orthotopic liver transplantation (OLT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction.
  
  
  METHODS
  From January 2001 to December 2009, 133 patients underwent OLT for ACLF at our center. Among them, 30 had both ACLF and renal dysfunction. Of the 30 patients, 12 underwent CLKT for end-stage renal disease (ESRD), and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent OLT alone. ACLF was defined according to the Asian Pacific Association for the Study of Liver Consensus Meeting. Clinical data were reviewed for survival outcomes.
  
  
  RESULTS
  The median model for end-stage liver disease score (MELD) of patients with ACLF was 28. Among the 133 patients, all of whom received deceased donor liver grafts, 12 also got the kidney grafts from the same deceased donor. The hospital mortality rate was 21.8% for all patients with ACLF. The 5-year survival rates were 72.8% for patients without renal dysfunction and 70% for patients with renal dysfunction. The results of patients with ESRD who underwent CLKT were better than those of subjects without renal dysfunction or patients with HRS1 who underwent OLT alone.
  
  
  CONCLUSIONS
  OLT alone improved renal function in most patients with HRS1, including those requiring short-term hemodialysis. Simultaneous liver-kidney transplantation was an excellent strategy for patients with both ACLF and ESRD. It provided protection to the kidney allograft for liver-based metabolic diseases affecting the kidney. The rate of acute rejection episodes in kidneys was low.
authors.affiliation: Department of General Surgery, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Organ Transplantation Center of Shanghai, Shanghai, China.
authors.forename: T
authors.initials: T
authors.lastname: Xing
authors.forename: L
authors.initials: L
authors.lastname: Zhong
authors.forename: D
authors.initials: D
authors.lastname: Chen
authors.forename: Z
authors.initials: Z
authors.lastname: Peng
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006530:Hepatorenal Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult