Combined liver and kidney transplantation

Abstract

Since the implementation of the model for end-stage liver disease scoring system for organ allocation in orthotopic liver transplantation in 2002, the number of combined liver and kidney transplantations (CLKTs) that have been performed in the USA has increased significantly. To standardize the evaluation and selection of CLKT candidates, consensus conferences were held in March 2006 and September 2007. In this article, we review the studies on CLKT, especially concentrating on studies published in 2008 and 2009, to assess the impact of the model for end-stage liver disease system and two consensus conferences. The hepatorenal syndrome, usually a reversible cause of renal failure, has to be differentiated from other causes of chronic kidney disease that are potentially nonreversible and mandate CLKT. Despite published guidelines, it still remains difficult to clearly delineate appropriate candidates for CLKT, especially when the cause of renal disease remains controversial. Performing renal biopsies might help in decision-making. Chronic kidney disease patients with glomerular filtration rate less than 30 ml/min, hepatorenal syndrome patients with requirement of renal replacement therapy more than 8-12 weeks, and patients with renal biopsy findings of more than 30% fibrosis and glomerulosclerosis would get benefit receiving CLKT. In this era of organ shortage, with tens of thousands of patients listed for kidney transplantation, it is paramount that the organs should be scrupulously allocated to those in real need. However, patients with advanced renal disease should not receive orthotopic liver transplantation alone, which significantly decreases their survival.