Simultaneous Liver, Kidney Transplantation: A Single Center Experience

Lee, Kyung Goo; Min, Sang Il; Ahn, Sanghyun; Park, Dae Do; Kim, Seo Min; Min, Seung Kee; Lee, Kwang Woong; Lee, Nam Joon; Suh, Kyung Suk; Kim, Sang Joon; Ha, Jongwon

Abstract

BACKGROUND
Simultaneous liver and kidney transplants have proved to be a favorable treatment for combined renal and hepatic end-stage diseases. However, it is extremely difficult to find a simultaneous liver and kidney donor in Korea due to the narrow requirements. This study had three aims: to explore the therapeutic experience of simultaneous liver and kidney transplants in Seoul National University Hospital (SNUH), to compare the overall survival outcome between simultaneous liver and kidney transplants and liver transplants alone in patients with liver and renal failure, and to determine the indications for simultaneous liver and kidney transplants.
METHODS
The clinical data of 8 simultaneous liver and kidney transplants at SNUH from November 2004 to October 2010 were retrospectively studied. Indications for simultaneous liver and kidney transplants, patient and graft survival, and the causes of death were analyzed and compared with 5 liver transplants alone performed on patients experiencing liver and renal failure.
RESULTS
The clinical characteristics of the recipients for simultaneous liver and kidney transplants and liver transplants alone were similar with regards to age, renal function, and the Model for End-Stage Liver Disease (MELD) score (all P>0.05). One patient died at 15 months after simultaneous liver and kidney transplants due to HBV related HCC recurrence, and three patients died at 2, 3, and 21 months after liver transplants due to ARDS, bleeding, and hepatic failure, respectively. Only one liver graft loss in simultaneous liver and kidney transplant cases occurred on POD 3 due to primary non-function. The outcome analysis demonstrated a superior overall survival in simultaneous liver and kidney transplants recipients compared with recipients of only liver transplants (P=0.041).
CONCLUSIONS
Simultaneous liver and kidney transplants showed a superior outcome in patients with end-stage liver disease and chronic renal failure compared with liver transplants alone. The allocation criteria of simultaneous liver and kidney transplants in Korea should be changed to expand its indications.