Combined Liver Kidney Transplant (CLKT) and Subsequent Kidney Transplant in Liver Transplant Recipients (KALT) in a Single Center.

Abstract

Background: The increasing survival in patients submitted to liver transplantation as well as the implementation of the MELD score has substantially increased the prevalence of chronic kidney disease (CKD) among these individuals. Aim: To evaluate the experience of a decade of CLKT and KALT in a Transplant Program with a large number of liver transplanted patients in São Paulo, Brazil. Methods: we performed a longitudinal and observational trial to evaluate the CLK and KAL transplants performed at the institution since the beginning of transplantation program at the institution, in 2002. The analyzed outcomes were: acute rejection (AR-k) and delayed graft function (DGF-k) in kidney graft, estimated glomerular filtration rate (GFR) and one year kidney graft survival. Results: In this period (2002 to May/2011), 56 transplants (CLKT and KALT) were performed: 39 were submitted to CLKT (69.6%) and 17 to KALT (30.4%). The main cause of liver failure in the study population was hepatitis C virus (HCV) infection, with no significant differences between CLKT (41%) and KALT (26%). The cause of CKD was undetermined in most patients (32.1%) of both subgroups, being the toxicity of calcineurin inhibitors the most important cause among KALT patients (0 vs. 29.4%). As expected, waiting time to transplant was longer in KALT than in CLKT (18.2 vs. 25.1 months p= 0.003). CIT was lower among KALT patients (13.0 vs. 21.2, p<0.001), and patients submitted to CLKT were inducted with Thymoglobulin more frequently: 8.1% vs. 80%, p<0.001. The prevalence of DGF-k was similar among both groups (66.7 vs. 70.6%, p=NS), despite of similar cold ischemia time. The prevalence of AR-k was 24.3% among KALT and 12.5% among CLKT (p=NS). It has been observed a trend towards higher 1-year-GFR in the KALT group (65.5 vs. 61.0 ml/min p = 0.63). Death was more frequent in CLKT (35.9% vs. 23.5%, p=0.26). Conclusion: acute rejection was more frequent in patients submitted to KALT, probably because of Thymoglobulin use. Graft function and death were similar among both groups.