Long-term analysis of combined liver and kidney transplantation at a single center

Arch Surg. 2006 Aug;141(8):735-41; discussion 741-2. doi: 10.1001/archsurg.141.8.735.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Graft Rejection / epidemiology
  • Graft Survival
  • Hepatorenal Syndrome / mortality
  • Hepatorenal Syndrome / surgery*
  • Humans
  • Incidence
  • Infant
  • Kidney Transplantation / methods*
  • Kidney Transplantation / mortality
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome