Abstract
BackgroundSince the introduction of the Model for End-stage Liver disease criteria in 2002, more combined liver kidney transplants are performed. Until 2017, no standard allocation policy for combined liver kidney transplant (CLKT) was available and each transplant center decided eligibility for CLKT or liver transplant alone (LTA) on a case-by-case basis. The aim of this systematic review was to compare the clinical outcomes of CLKT compared to LTA in patients with renal dysfunction. MethodsDatabases were systematically searched for studies published between January 2010 and March 2021. Outcomes were expressed as risk ratios and pooled with a random-effects model. The primary outcome was patient survival. ResultsFour studies were included. No differences were observed for mortality risk at 1 year (risk ratio (RR) 1.03 [confidence interval (CI) 0.97–1.09], 3 years (RR 1.06 [CI 0.99–1.13]) and 5 years (RR 1.08 [CI 0.98–1.19]). The risk of graft loss was similar in the first year (RR 1.10 [CI 0.93–1.30], while 3-year risk of graft loss was significantly lower in CLKT patients (RR 1.15 [CI 1.08–1.24]). ConclusionsCLKT has similar short-term graft and patient survival as LTA in patients with renal dysfunction. More data is needed to decide from which KDIGO stage patients benefit the most from CLKT.
Highlights
Pretransplant renal dysfunction is an important determinant of morbidity and mortality following liver transplantation [1]
Definitions of renal dysfunction differ, with some stating that it should be defined according to a certain KDIGO stage and serum creatinine, while others state that renal dysfunction cannot be based on a laboratory value as complications of kidney disease can occur even at a relatively low creatinine level and need for Renal Replacement Therapy (RRT) is not determined by glomerular filtration rate (GFR) alone
Our results show that Combined Liver Kidney Transplant (CLKT) has similar survival outcomes as Liver Transplant Alone (LTA) in patients with both end stage liver disease and renal dysfunction with a trend towards better long-term survival in CLKT patients
Summary
Pretransplant renal dysfunction is an important determinant of morbidity and mortality following liver transplantation [1]. Combined liver kidney transplantation (CLKT) has been employed as a treatment modality for individuals with end-stage liver disease and renal dysfunction abrogating this risk [2,3,4]. CKLT is straightforward for patients with both end-stage liver and renal disease necessitating renal replacement therapy (RRT). It is less welldefined for patients with mild to moderate renal dysfunction and those with causes of acute renal failure, including hepato-renal syndrome, due to the potential reversibility of renal failure after LTA. Since the introduction of the Model for End-stage Liver disease criteria in 2002, more combined liver kidney transplants are performed. More data is needed to decide from which KDIGO stage patients benefit the most from CLKT
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