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Simultaneous liver and kidney transplantation.
Current Opinion in Nephrology and Hypertension 2007 November
PURPOSE OF REVIEW: The Model for End-Stage Liver Disease (MELD) scoring system for prioritizing patients for liver transplantation heavily weights serum creatinine, leading to increased numbers of liver transplant patients with renal insufficiency receiving both liver-alone transplants and liver-kidney transplants. With available organs being scarce, review of recent outcomes and guidelines for their use is timely.
RECENT FINDINGS: Despite lower average renal function in liver transplant recipients in the era of Model for End-Stage Liver Disease scoring, and poor renal function predicting inferior outcomes, overall outcomes are unchanged. Combined liver-kidney transplants have increased three-fold. Despite inferior short-term kidney and liver-graft survival rates, long-term success rates are equivalent to single-organ transplantation. Only patients requiring dialysis at the time of transplantation clearly benefit from combined liver-kidney transplants. Waitlisted patients with nonresolving severe acute kidney injury for 6-8 weeks or substantial irreversible renal parenchymal damage are also deemed appropriate candidates. Many combined liver-kidney recipients have lesser degrees of renal dysfunction, however. Accurate determination of renal function in patients with cirrhosis remains problematic.
SUMMARY: Appropriate patients with irreversible end-stage renal and liver disease clearly deserve combined liver-kidney transplants. More data on the reliable assessment of renal function, renal pathology, and outcomes are needed, however.
RECENT FINDINGS: Despite lower average renal function in liver transplant recipients in the era of Model for End-Stage Liver Disease scoring, and poor renal function predicting inferior outcomes, overall outcomes are unchanged. Combined liver-kidney transplants have increased three-fold. Despite inferior short-term kidney and liver-graft survival rates, long-term success rates are equivalent to single-organ transplantation. Only patients requiring dialysis at the time of transplantation clearly benefit from combined liver-kidney transplants. Waitlisted patients with nonresolving severe acute kidney injury for 6-8 weeks or substantial irreversible renal parenchymal damage are also deemed appropriate candidates. Many combined liver-kidney recipients have lesser degrees of renal dysfunction, however. Accurate determination of renal function in patients with cirrhosis remains problematic.
SUMMARY: Appropriate patients with irreversible end-stage renal and liver disease clearly deserve combined liver-kidney transplants. More data on the reliable assessment of renal function, renal pathology, and outcomes are needed, however.
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