Abstract:
BACKGROUND:The role of combined liver-kidney transplantation (CLKT) for cirrhotic patients with renal failure (RF) is controversial. Since the model for end-stage liver disease era, there has been a rise in the number of CLKT. Using the Organ Procurement Transplant Network/United Network for Organ Sharing database, this study was undertaken to compare outcomes of cirrhotic patients with RF who received either liver transplant alone (LTA) or CLKT between 2002 and 2008. METHODS:Analysis was limited to cirrhotic patients 18 years old or older, with serum creatinine level 2.5 mg/dL or higher at the time of orthotopic liver transplantation (OLT) or who received dialysis at least twice during the week before OLT. Patients who received CLKT were categorized based on the cause of their underlying RF. RESULTS:Overall liver allograft and patient survival rates of LTA patients were significantly lower compared with CLKT patients (P<0.001). CLKT patients with hepatorenal syndrome showed significantly higher patient and liver allograft survival rates. Liver allograft survival was superior among CLKT patients irrespective of whether they received dialysis. Prevalence of posttransplantation RF was higher for LTA patients at 6 months and 3 years of follow-up (P<0.001). LTA was a significant risk factor both for graft loss and mortality. Recipient hepatitis C virus seropositivity, donor age, donor cause of death, and life support at the time of OLT were also risk factors for graft loss and death. CONCLUSIONS:Cirrhotic patients with RF, in particular with hepatorenal syndrome, CLKT is preferable to LTA because it improves liver allograft and patient survival.
journal_name
Transplantationjournal_title
Transplantationauthors
Fong TL,Khemichian S,Shah T,Hutchinson IV,Cho YWdoi
10.1097/TP.0b013e3182590d6bsubject
Has Abstractpub_date
2012-08-27 00:00:00pages
411-6issue
4eissn
0041-1337issn
1534-6080journal_volume
94pub_type
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