A Novel Approach in Combined Liver and Kidney Transplantation With Long-term Outcomes

Abstract

Delayed KT in CLKT (especially if delayed >48 h) is associated with improved kidney function with no DGF post-KT, and improved patient and graft survival.

Factors predicting kidney delayed graft function among recipients of simultaneous liver‐kidney transplantation: A single‐center experience

“…Such a policy may provide better chances for ESLD patients with concurrent RD who are too sick to go through this complex SLKT in that if they received LT initially and continued to show persistent RD post-LT (ie, chronic dialysis dependence or GFR ≤ 20 mL/min), they will be prioritized to receive kidney transplant once listed in the period from 60 to 365 days following LT. 55 The use of HPMP with delay in performing CRT after LT was recently proposed and published by the Indiana group who concluded that delaying CRT for more than 48 hours post-LT is not associated with kDGF and provides improved graft function, as well as better patient and graft survival. 30 While, as noted above, the fundamental difference in patient populations between the two studies may explain why we found delay to be associated with worse results instead, their results support the notion that use of HPMP in and of itself did not significantly reduce or prevent the development of kDGF. Rather, allowing patient recovery and better hemodynamic stability by delaying the kidney transplant surgery after LT helps to improve outcomes.…”

“…This is consistent with the findings reported by the group from Indiana University and the group from the University of Miami where kDGF was a strong independent predictor of patient mortality following SLKT. 30,52 …”

Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria

“…There is also an unknown question of whether the defect in oxalate transporter in the remaining portion of native duodenum (15-20 cm) and rectum (15-20 cm) would suffice to induce oxalosis over full length working transplanted intestine. Moreover, in our case, the expression of SLC26A6 was significantly less intense in the transplanted small intestine as well, which adds another unknown in the field re- The early dysfunction of the renal allograft due to the use of high pressors and blood transfusion could be avoided by the delayed implantation of the kidney allograft in CIKTx, as shown in combined liver-kidney transplantation by our group [19] . We usually delay the implantation of the kidney allograft up to 3 days in combined liver-kidney transplantation, supporting the kidney allograft by continuous hypothermic machine perfusion [19] .…”

“…Moreover, in our case, the expression of SLC26A6 was significantly less intense in the transplanted small intestine as well, which adds another unknown in the field re- The early dysfunction of the renal allograft due to the use of high pressors and blood transfusion could be avoided by the delayed implantation of the kidney allograft in CIKTx, as shown in combined liver-kidney transplantation by our group [19] . We usually delay the implantation of the kidney allograft up to 3 days in combined liver-kidney transplantation, supporting the kidney allograft by continuous hypothermic machine perfusion [19] . The delayed implantation of kidney allograft in combined liver-kidney transplantation enabled us to hemodynamically stabilize our recipients post liver transplantation, which offers a less hostile environment for the kidney allograft.…”

Evolution of Liver Transplantation Program in Shiraz, Iran

“…Improved surgical techniques and better preoperative care including availability of better protocols of immunosuppressive treatments have improved outcomes of LT including survival of recipients (5)(6)(7). Despite this improvement, there is still an excess risk of death in long-term survivors with an estimated loss of 7 years of life compared to 6 and age matched general population, with a greater difference in younger recipients (8).…”