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Simultaneous Liver-Kidney Transplantation for Adult Recipients With Irreversible End-Stage Renal Disease
E. Moreno-Gonzalez, MD, PhD, FACS(Hon);
J. C. Meneu-Diaz, MD, PhD;
I. Garcia, MD;
F. Perez Cerdá, MD;
M. Abradelo, MD, PhD;
C. Jimenez, MD, PhD;
C. Loinaz, MD, PhD;
R. Gomez, MD, PhD;
A. Gimeno, MD;
A. Moreno, MD, PhD
Arch Surg. 2004;139:1189-1193.
Hypothesis Combined liver-kidney transplantation is safe (low morbidity and acceptable mortality) and effective in patients with end-stage liver disease. Although refinements in surgical technique have resulted in better patient and allograft outcomes, the negative impact of renal insufficiency on survival in patients undergoing liver transplantation has been widely reported, although some aspects are controversial.
Design Analysis of the clinical characteristics and outcome in the management of patients undergoing combined liver-kidney transplantation. The end points were operative mortality, morbidity, and long-term survival.
Setting University Hospital 12 de Octubre.
Patients Between May 1986 and December 2001, 820 liver transplantations were performed. There were 16 cases (1.96%) of combined liver-kidney transplantations, which represent the sample of this study.
Results Mean ± SD follow-up of 42.2 ± 29 months: 6 patients died (37.5% mortality rate). There were 4 (25%) hospital deaths within 6 months following surgery and 2 after 6 months (4 sepsis, 1 refractory heart failure, and 1 recurrent hepatitis C virus disease). Univariate analysis related to mortality included age, sex, etiology, preoperative creatinine level, United Network for Organ Sharing status, Child-Pugh score, type of hepatectomy (piggyback), intraoperative blood product administration, and the presence of postoperative complications. The only 2 significant factors were the presence of postoperative complications (P = .01) and the United Network for Organ Sharing status (P = .02). Crude survival rate was 62.5%. Actuarial survival rates were 80%, 71%, and 60% at 1, 3, and 5 years, respectively.
Conclusion Because end-stage renal disease is not a formal contraindication for liver transplantation, a combined liver-kidney transplantation for adults with end-stage renal disease can be done safely and effectively.
Author Affiliations: Department of General, Digestive, and Abdominal Organs Transplantation, University Hospital 12 de Octubre, Madrid, Spain.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Long-term Analysis of Combined Liver and Kidney Transplantation at a Single Center
Ruiz et al.
Arch Surg 2006;141:735-742.
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