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Richard Ruiz, MD; Hiroko Kunitake, MD; Alan H. Wilkinson, MD; Gabriel M. Danovitch, MD; Douglas G. Farmer, MD; Rafik M. Ghobrial, MD, PhD; Hasan Yersiz, MD; Jonathan R. Hiatt, MD; Ronald W. Busuttil, MD, PhD

Arch Surg. 2006;141:735-742.

Objective  To analyze use of combined liver and kidney transplantation (CLKT) for patients with chronic primary diseases of both organs and for patients with hepatorenal syndrome.

Design  Retrospective case series.

Setting  Multiorgan transplantation service in a large university medical center.

Patients  A total of 98 patients underwent 99 CLKTs during a 16-year period; 76 had primary renal diseases, and 22 had hepatorenal syndrome. Patients receiving isolated liver and kidney transplants were analyzed for comparison.

Main Outcome Measures  Patient and graft survival, rejection rates, and need for hemodialysis before and after transplantation.

Results  Overall patient survival was 76%, 72%, and 70% at 1, 3, and 5 years, respectively; liver graft survival was 70%, 65%, and 65%; and kidney graft survival was 76%, 72%, and 70%. No risk factors analyzed for recipients or donors were associated significantly with early posttransplantation mortality or graft loss. In 28 patients who received monoclonal antibody induction therapy with interleukin 2 blockers, there were significantly fewer episodes of acute liver rejection. For patients with hepatorenal syndrome, CLKT did not confer a survival advantage over liver-only transplantation (1-year patient survival was 72% vs 66%; P = .88). The 1-year acute kidney rejection rate in the adult CLKT group was 14% vs 23% in a 5-year cadaveric renal transplantation cohort (P<.01).

Conclusions  First, CLKT is indicated in patients with dual organ disease and achieves excellent results. Second, CLKT for hepatorenal syndrome is indicated in patients receiving hemodialysis for longer than 8 weeks and confers advantages in patient survival and use of hospital resources. Third, the liver is immunoprotective for the kidney.

Author Affiliations: Department of Surgery, Dumont-UCLA Transplant Center (Drs Ruiz, Kunitake, Farmer, Ghobrial, Yersiz, Hiatt, and Busuttil), and Department of Medicine, David Geffen School of Medicine (Drs Wilkinson and Danovitch), University of California, Los Angeles.

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