Indications and timing for combined liver and kidney transplantation

doi:10.3969/j.issn.2095-4344.2013.05.011

Abstract

Abstract:

BACKGROUND: Since the development of liver and kidney transplantation, renal insufficiency and renal failure are no longer contraindications for liver transplantation.
OBJECTIVE: To explore the indications and timing for performing combined liver and kidney transplantation and to allocate the scarce organs rationally.
METHODS: The clinical data were reviewed in 15 patients with combined liver and kidney transplantation including the diagnosis of primary diseases and distinct hepatorenal function before operation, and the situations of transplanted kidneys and original kidneys were analyzed.
RESULTS AND CONCLUSION: All patients were operated successfully and being alive now. The follow-up time was 1.5－8 years, and the mean time was (3.6±1.2) years. Among the 15 patients with combined liver and kidney transplantation, one patient had delayed renal function recovery, and then recovered after treated with continuous renal replacement therapy for 2 weeks; for one patient who had hepatorenal syndrome and was treated with continuous renal replacement therapy for 4 weeks prior to transplantation, the renogram examination at 2 months after renal transplantation showed the original kidney function was recovered; for another two patients who had hepatorenal syndrome and were treated with continuous renal replacement therapy for 6 weeks prior to transplantation, the renogram examination after transplantation showed the original kidney function was not recovered. For the patients who had end-stage liver disease and primary nephrotic syndrome, the urine protein > 500 mg, glomerular filtration rate < 30 mL/min or the puncture biopsy confirmed that the glomerulosclerosis rate > 30% before transplantation, the renogram examination after combined liver and kidney transplantation showed original renal dysfunction. The patients with hepatorenal syndrome who had been treated with continuous renal replacement therapy for more than 6 weeks before transplantation should be treated with combined liver and kidney transplantation. However, the patients with end-stage liver disease and primary nephrotic syndromethe should be treated with combined liver and kidney transplantation if the urine protein > 500 mg, glomerular filtration rate < 30 mL/min or the puncture biopsy confirmed that the glomerulosclerosis rate > 30%.

Key words: organ transplantation, liver transplantation, combined liver and renal transplantation, indications, continuous renal replacement therapy, the timing for transplantation, renal function, urine protein, glomerulosclerosis rate, puncture biopsy, immunosuppressants, other grants-supported paper

CLC Number:

R318

Du Guo-sheng, Shi Bing-yi, Song Ji-yong, Zhu Zhi-dong, Zheng De-hua, Cui Hong-tao. Indications and timing for combined liver and kidney transplantation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(5): 832-836.

Figures/Tables 1

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