J Korean Soc Transplant.  2010 Dec;24(4):243-247.

Multiple Organ Transplantation: Combined Liver-Kidney Transplantation

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ysms91@yuhs.ac
  • 2The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Coexisting end stage liver disease (ESLD) and end stage renal disease (ESRD) for a patient on dialysis is a standard indication for a combined liver-kidney transplantation (CLKT). A survival advantage after CLKT has been verified in liver transplant candidates with significant kidney dysfunction due to chronic kidney disease (CKD) or acute kidney injury (AKI). The severity (glomerular filtration rate (GFR) < or =30 mL/min) and duration (more than 8~12 weeks) of kidney dysfunction are strong determinants for the selection of CLKT candidates. The CLKT patient survival rate is superior to that of liver transplant alone in candidates with a serum creatinine >2.0 mg/dL or who are on dialysis. Because of the immunological modulation effect of the liver graft, post-transplant CLTX results in a lower incidence of acute rejection and higher long-term censored graft survival rate in kidney transplant recipients. Despite the advantages of CLKT, the CLKT waiting list is extremely rare in Korea (0.80%, 67/3,717, from recent Korean Network for Organ Sharing (KONOS) data on March 2010). The narrow indications for CLKT (only ESRD candidates on dialysis are accepted for CLKT) and inferior ranking of CLKT for kidney allocation is a pitfall of the multi-organ allocation rule in KONOS.

Keyword

Multiple organ transplantation; Combined liver and kidney transplantation; Allocation

MeSH Terms

Acute Kidney Injury
Creatinine
Dialysis
End Stage Liver Disease
Filtration
Graft Survival
Humans
Imidazoles
Incidence
Kidney
Kidney Failure, Chronic
Korea
Liver
Nitro Compounds
Rejection (Psychology)
Renal Insufficiency, Chronic
Survival Rate
Transplants
Waiting Lists
Creatinine
Imidazoles
Nitro Compounds

Reference

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