Introduction:
End-stage liver disease (ESLD) and end-stage renal disease (ESRD) are prevalent diseases for which the definitive treatment is transplantation. Combined liver and kidney transplantation is a life saving procedure for patients with combined liver and kidney failure or metabolic liver diseases leading to renal failure.We present our experience with Combined liver kidney transplantation for various causes.
To analyze the experience with combined liver-kidney transplantation in a tertiary care center in South India .
Methods:
Retrospective analysis of 6 patients who had done Combined liver kidney transplantation from 2015 to 2023 at VPS Lakeshore Hospital and Research Center, Kochi was done. Transplants were performed using grafts from both deceased donors as well as live donors.Analyzed parameters include gender, age, MELD score at the operation, liver cold and warm ischemic times, indication for combined liver and kidney transplant , immunosuppressive regimen ,posttransplant complications , patient and graft survival and follow-up . Transplants were performed using grafts from both deceased donors and live donors . After completion of liver transplantation, the kidney graft was implanted retroperitoneally. Maintenance Immunosuppressive therapy consisted of tacrolimus ,mycophenolate, prednisone in all patients.
Results:
Six combined liver-kidney transplantations were performed in the same period, which corresponds to 1% and 10 % of the kidney and liver transplants, respectively. 5 were male (83.3 %) and one was female (16.6%). 4 patients undergone deceased donor transplantation and 2 patients undergone live donor transplantation.The average patients and donors age was 44.83±2 and 30.7 ±2 , respectively. The MELD score mean was 25 ±4.2 . Primary hyperoxaluria both type 1 and type 2 were indications for two patients . The main cause of liver dysfunction were NASH (n=3), HCV related (1) . As for renal dysfunction, diabetic nephropathy (n=2) was the most frequent.
The mean liver cold and warm ischemic time was 80 mins . and 29.2 ± 7.9 minutes, respectively. The average length of hospital stay was 30 days
Surgical complications occurred in one patient; he had hepatic artery thrombosis for which thrombolysis was done . One patient had liver rejection which was treated .In two cases was observed acute renal allograft dysfunction of which one was due to Tacrolimus toxicity and other due to cellular rejection.Intensive preoperative high flux dialysis and intraop CRRT done for 2 patients with primary hyperoxaluria to reduce oxalate load . There was one death (14%) due to sepsis . Surviving 5 patients have stable liver and kidney graft function..The three year survival rate in patients was 80 %.
Conclusions:
In conclusion ,Simultaneous liver and kidney transplantation (SLKT) is a safe and viable option for liver transplant candidates with end‐stage kidney disease (ESKD) and sustained acute kidney injury (AKI) unlikely to recover after liver transplantation, and those with inborn metabolic diseases to help mitigate the risk of posttransplant renal dysfunction .
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.