Combined Liver and Kidney Transplantation

Combined liver and kidney transplant (CLKT) is the procedure of choice for patients with both liver and kidney end-stage-disease. In addition, patients with polycystic liver or kidney disease or with hyperoxaluria, or those with cirrhosis and acute renal failure, including hepatorenal syndrome receiving hemodialysis (HD) for more than two months, may also benefit of CLKT. The decision to transplant both, the liver and kidney, is more difficult in cases when kidney dysfunction may be temporary. Hepatorenal syndrome is a potentially reversible renal failure caused by advance liver disease. Currently, the treatment of choice of hepatorenal syndrome is liver transplant alone and not a combined liver/kidney transplant. The model for end-stage liver disease (MELD) replaced the United Network for Organ Sharing status classification for the allocation of liver organs. Due to the heavily weighted serum creatinine value in the calculation of the MELD score, candidates with renal failure have received organs more rapidly. As a result there has been considerable increase in number of combined liver-kidney transplants in the past few years. The reason to propose both liver and kidney transplant for patients with cirrhosis and renal failure relays on the negative impact that renal failure has on patients submitted to liver transplant alone (LTA). Results of several studies show that renal failure in patients with chronic liver disease is associated with high mortality and morbidity after liver transplant alone. Nevertheless, it’s very hard to identify a cut-off point of renal dysfunction that determines those patients who may benefit from combined liver and kidney transplant instead of liver transplant alone. In this chapter, we will review the main points to be considered when evaluating candidates for combined liver kidney transplant, as well as some concerns that have not been yet clarified.