Since 2002, when the end-stage liver disease model (MELD) score was adopted, the number of combined liver-kidney transplantations increased.

Between January 1995 and December 2011 we performed 38 combined liver-kidney transplantation (CLKT) and 6 sequential liver-kidney transplantation (SLKT).

This study compares the outcomes of CLKT and SLKT with the controlateral kidneys (31 of the first group and 6 of the second one) used for the kidney alone transplantation (KTA 1 and 2).

The indications for CLKT were: polycystic disease (60,6%), primary Hyperoxaluria type 1 (21%), end-stage kidney disease and cirrhosis (18,4%).

In SLKT, the major cause of renal failure was calcineurin inhibitor nephropathy (83,3%) and dialysis started on a 7 years average time after liver transplantation.

Delayed renal graft function (DGF) occurred in the 52,6% of CLKT vs. 38,7% in the KTA, despite a minor cold ischemia time and lower donor age in CLKT group.

Infections and bleedings were more common in CLKT patients (86,8% vs. 61,5% in KTA1 p=0,034), as well as surgical complications (42% vs. 11,5% in KAT1 p=0,03).

The immunosuppressive protocol mostly used was tacrolimus, mycophenolate mofetil and prednisone. In CLKT recipients tacrolimus levels were lower and steroid was stopped earlier than KTA.

The acute renal rejection frequency was lower in CLKT (2,8% in CLKT, 7,7% in KTA1 and 16,6% in SLKT, p = not significant) despite a major HLA mismatch, positive X-match, specific anti-donor antibody and lower immunosuppression.

Mean creatinine serum levels were lower in CLKT.

At 5 years, patient survival rates in SLKT were lower than those in CLKT (75% in SLKT vs 90% in CLKT), and in KAT1-2 (100%). Kidney graft survival rates at 1, 5 years were 92% and 84% in CLKT, 100% and 75% in SLKT, 97% and 97% in KAT1, 100% and 100% in KAT2. CLKT and KAT1 kidney graft survival compared using “death censored curves” was the same in both groups (97%) at 1 and 5 years.

In conclusion in CLKT recipients, although complications and mortality were more frequent in the first three months after transplantation, the patient and kidney allograft survival rates appeared to be superior than those in SLKT. In addition, in CLKT there were lower serum creatinine levels despite a major incidence of DGF.

These results seems confirme that the liver allograft has an immunoprotective effect on the renal allograft from the same donor.

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