Introduction and aim: Recent data has shown that Liver with kidney transplantation preserves better renal function of the kidney allograft in PH related end stage renal disease. We wanted to test this hypothesis by comparing kidney transplant alone (KTA) versus liver-kidney transplant (LKT). A second objective of this study was to determine if kidney after liver (KAL) gives better results than simultaneous liver kidney transplantation (SLK).

Methods: From January 1985 until December 2012 twenty patients who underwent transplantation for PH at our institute were reviewed. Patients were initially split into 2 groups (KTA and LKT) for analysis. Basic demographics were compared. Univariate analysis was used to compare the outcomes (Long term dialysis, GFR at 1 month, 1 year, 3 year and 5 year post transplant). The whole analysis was then repeated for patients who only underwent LKT thus comparing KAL versus SLK. Actuarial kidney graft survivals were compared where appropriate using the log rank test.

Results: Three patients who were intended to be treated as KAL died while on the kidney waiting list and were therefore excluded from analysis. Twelve patients had LKT (70.6%) and 5 underwent KTA (29.4%). Initially there was no significant differences in GFR at 1 month ,1 year and 3 year but GFR at 5 years was significantly worse in KTA patients (11.38±12.76 vs 47.84±13.91; p=0.002). This resulted in more patients requiring long term dialysis after KTA (80% vs. 16.7%; p=0.028) and worse 1 and 3 year actuarial graft survival (80% vs. 100% and 40% vs. 90% respectively p=0.026).

In the second analysis there were no differences found in the KAL (n=8) vs. SLK (n=4) in terms of GFR, graft loss and long term dialysis albeit the low numbers in this cohort. The median waiting time for a kidney after liver transplant was 39 months (12-304m) when excluding live donor kidney transplants.

Conclusion: LKT provides better kidney allograft survival than KTA. There was no difference in this small sample found between SLK and KAL albeit the higher risk of death on the waiting list in the KAL when there is no living donor option. Larger studies are needed to evaluate the difference between KAL and SLK.

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