Clinical

Combined liver-kidney transplant yields excellent results

Last Updated: 2006-08-23 10:03:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Survival rates and organ function are excellent in patients who require combined liver and kidney transplants, according to a report in the August Archives of Surgery.

Dr. Richard Ruiz and colleagues from University of California, Los Angeles, reviewed their 16-year experience with 98 patients who underwent combined liver and kidney transplantation, including 22 patients who had hepatorenal syndrome.

Thirty-one patients died during a median follow-up of 36 months (range, 0 to 161 months), the authors report, yielding overall survival rates of 76% at 1 year, 72% at 3 years, and 70% at 5 years.

Liver graft survival rates were 70%, 65%, and 65%, respectively, for the same intervals, the results indicate, and kidney graft survival rates were 76%, 72%, and 70%, respectively.

In the subgroup of patients with hepatorenal syndrome, the 1- and 3-year patient survival rates were both 72%, the researchers note, which compared favorably with the rates among patients who underwent liver transplant only.

Renal function returned promptly in most hepatorenal syndrome patients who underwent only liver transplant, the report indicates, but results were superior for combined liver and kidney transplant in patients who required more than 8 weeks of hemodialysis before the transplant.

"We therefore recommend combined liver and kidney transplant for patients who have hepatorenal syndrome and receive hemodialysis longer than 8 weeks," the investigators write.

"Combined liver and kidney transplantation offers the best option for patients with simultaneous chronic liver and kidney failure when it is performed at a high-volume academic transplant center," the authors conclude.

Patients who recently underwent combined liver and kidney transplant have improved overall survival and graft survival "most likely because of better perioperative medical management, shorter graft ischemia time, and more effective immunosuppressive regimens," they add.

Arch Surg 2006;141:735-742.