Living Donor Liver Transplantation Alone Is Not Inferior to Combined Kidney Liver Transplant for Cirrhotic Patients With Chronic Kidney Disease |
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| Affiliation: | 1. Center for Liver and Biliary Sciences, Max Healthcare, Saket, New Delhi, India;2. Apollo Institute of Liver Sciences, Liver Transplant Unit, Apollo Hospital, Chennai, India;3. Shahid Dharmabhakta National Transplant Center, Department of HBP and Liver transplantation, Kathmandu, Nepal;1. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;2. Division of Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, Missouri;1. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri;2. Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri;3. Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri;1. Clinic for Nephrology, Clinical Center of Montenegro, Podgorica, Montenegro;2. Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia;3. Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia;4. Clinic for Urology, University Hospital Center Zagreb, Zagreb, Croatia;1. Section of Renal Transplantation, Edward Hines VA Jr Hospital, Hines, Illinois;2. Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois;3. Department of Medicine, Division of Transplant Nephrology, Stritch School of Medicine, Maywood, Illinois;1. Wayne State University School of Medicine, Detroit, Michigan;2. Henry Ford Hospital Department of Gastroenterology and Hepatology, Detroit, Michigan;3. Duke University Department of Gastroenterology, Durham, North Carolina;4. Henry Ford Hospital Department of Transplant Surgery, Detroit, Michigan;5. Duke University, Department of Transplant Surgery, Durham, North Carolina;1. Private Inova Hospital, Urology, Aksaray, Turkey;2. Asklepios Klinik Triberg, Urology, Triberg, Germany;3. University of Health Sciences, Ankara City Hospital, Department of Urology, Ankara, Turkey;4. Bingol State Hospital, Department of Urology, Bingol, Turkey |
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| Abstract: | BackgroundChronic kidney disease (CKD) is common in patients with chronic liver disease (CLD) as is acute kidney injury (AKI). The differentiation between CKD vs AKI is often difficult and sometimes the both may coexist. A combined kidney–liver transplant (CKLT) may result in a kidney transplant in patients whose renal function is likely to recover or at least who have stable renal function post-transplant. We retrospectively enrolled 2742 patients who underwent living donor liver transplant at our center from 2007 to 2019.MethodsThis audit was carried out in liver transplant recipients with CKD 3 to 5 who underwent either liver transplant alone (LTA) or CKLT to look at outcomes and long-term evolution of renal function. Forty-seven patients met the medical eligibility criteria for CKLT. Of the 47 patients, 25 underwent LTA and the rest 22 underwent CKLT. The diagnosis of CKD was made according to the Kidney Disease: Improving Global Outcomes classification.ResultsPreoperative renal function parameters were comparable between the 2 groups. However, CKLT patients had significantly lower glomerular filtration rates (P = .007) and higher proteinuria (P = .01). Postoperatively, renal function, and comorbidities were comparable between the 2 groups. Survival was similar at 1, 3, and 12 months, respectively (log-rank; P = .84, = .81, and = .96, respectively). At the end of the study period, 57% of patients who survived in LTA groups had stabilized renal function (Creatinine = 1.8 ± 0.6 mg/dL).ConclusionsLiver transplant alone is not inferior to CKLT in living donor situations. Renal dysfunction is stabilized in the long term whereas long-term dialysis may be carried out in others. Living donor liver transplantation alone is not inferior to CKLT for cirrhotic patients with CKD. |
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