Combined liver–kidney transplantation for polycystic liver and kidney disease: analysis from the United Network for Organ Sharing dataset

Coquillard, Cristin; Berger, Judith; Daily, Michael F.; Shah, Malay B.; Mei, Xiaonan; Martí, Francesc; Gedaly, Roberto

doi:10.1111/liv.13041

Cited by 26 publications

(16 citation statements)

References 16 publications

(22 reference statements)

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“…Factors associated to increased risk of graft loss are mainly related to the aetiology of cirrhosis such as the HCV infection, the severity of liver disease, that is higher bilirubin level, and to the ischaemia suffered by the graft, in particular grafts from older donors. Polycystic disease, otherwise, often associated with less severe liver disease, was associated with superior graft survival and this further confirm the pivotal role of liver disease aetiology on patient outcome , amongst other known donor characteristics, such as donor age and CIT .…”

Section: Discussionsupporting

confidence: 58%

Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

et al. 2019

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Patient selection for combined liver-kidney transplantation (CLKT) is a current issue on the background of organ shortage. This study aimed to compare outcomes and post-transplant renal function for patients receiving CLKT and liver transplantation alone (LTA) based on native renal function using estimated glomerular filtration rate (eGFR) stratification. Using the UK National transplant database (NHSBT) 6035 patients receiving a LTA (N = 5912; 98%) or CLKT (N = 123; 2%) [2001][2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013] were analysed, and stratified by KDIGO stages of eGFR at transplant (eGFR group-strata). There was no difference in patient/graft survival between LTA and CLKT in eGFR group-strata (P > 0.05). Of 377 patients undergoing renal replacement therapy (RRT) at time of transplantation, 305 (81%) and 72 (19%) patients received LTA and CLKT respectively. A significantly greater proportion of CLKT patients had severe end-stage renal disease (eGFR < 30 ml/min/1.73 m 2 ) at 1 year post-transplant compared to LTA (9.5% vs. 5.7%, P = 0.001). Patient and graft survival benefit for patients on RRT at transplantation was favouring CLKT versus LTA (P = 0.038 and P = 0.018, respectively) but the renal function of the long-term survivors was not superior following CLKT. The data does not support CLKT approach based on eGFR alone, and the advantage of CLKT appear to benefit only those who are on established RRT at the time of transplant. Transplant International 2019; 32: 918-932

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Section: Discussionsupporting

confidence: 58%

Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

et al. 2019

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“…Combined liver-kidney transplantation in patients with ADPKD and severe renal impairment should be considered, as evidence shows that it is associated with better outcomes (patient and graft survival) compared to liver transplantation alone. 77 We suggest a multidisciplinary approach involving hepatologists and nephrologists for this group of patients.…”

Section: Patient: 'I Want To Be Cured!' Liver Transplantationmentioning

confidence: 99%

Clinical management of polycystic liver disease

Aerts

Laarschot

Bañales

et al. 2018

Journal of Hepatology

127

209

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In this Grand Rounds article, we present a typical case of a woman with polycystic liver disease. This case prompts questions which both patients and clinicians may face in clinical practice. This article aims to provide guidance to clinicians caring for patients with polycystic liver disease, in relation to key recent developments in the field. We discuss the latest advances in our understanding of pathophysiology, the natural course of disease, complications, as well as existing and potential new treatment options.

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“…Polycystic liver and kidney disease is a frequent and increasing indication for SLK [3]. In Eurotransplant, 32% of SLK were performed for polycystic disease in 2004, increasing to 51% in 2013 [4].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous liver kidney transplantation and (bilateral) nephrectomy through a midline is feasible and safe in polycystic disease

et al. 2017

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In Eurotransplant, 50% of simultaneous liver kidney transplantations (SLK) are performed for polycystic disease. Classically, liver and kidney are transplanted in two steps: liver through a subcostal incision, kidney through a separate oblique incision. Liver and kidney volume can make this ‘two-step’ procedure challenging, especially if simultaneous native nephrectomy is indicated. A ‘one-step’ SLK through a xiphopubic laparotomy might be a safe alternative, facilitating mobilization of the voluminous polycystic liver and native nephrectomy whilst offering access to iliac fossae for kidney transplantation. One-step SLK procedures for polycystic disease were introduced in 08/2013 at IKEM Prague (n = 6) and 11/2014 at University Hospitals Leuven (n = 6). Feasibility and safety of the one-step technique were investigated. We compared surgical data and outcomes obtained with the one-step technique to all consecutive two-step procedures performed for polycystic disease at the University Hospitals Leuven between 2008–2014 (n = 23). Median (interquartile range) are given. One-step SLK offered broad and adequate exposure for the hepatectomy, nephrectomies and transplantations, which were all uneventful. Morbidity, patient (100% vs 91%, p = 0.53) and graft survival (100% graft survival for liver and kidney in both groups) were comparable between one-step and two-step SLK. Liver cold ischaemia time was comparable [6.0 (4.4–7.6) vs. 7.1 (3.9–7.3), p = 0.077], kidney cold ischaemia time was shorter in one-step compared to two-step SLK [8.1 (6.4–9.3) vs. 11.7 (10.0–14.0), p<0.001)]. Total procedural time was also shorter in one-step compared to two-step SLK [6.8 (4.1–9.3) vs. 9.0 (8.7–10.1), p = 0.032], while all underwent bilateral (67%) or unilateral (33%) nephrectomy (compared to 0% and 52% in two-step SLK, respectively). In one-step SLK, 67% received a pre-emptive kidney transplant compared to 46% in two-step SLK. 5/12 two-step SLK became dialysis dependant after pre-transplant nephrectomy, the 4 dialysis-dependant patients with one-step SLK had not undergone pre-transplant nephrectomy. In conclusion, one-step SLK for polycystic disease is feasible and safe.

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Combined liver–kidney transplantation for polycystic liver and kidney disease: analysis from the United Network for Organ Sharing dataset

Cited by 26 publications

References 16 publications

Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

Combined liver–kidney transplantation versus liver transplant alone based on KDIGO stratification of estimated glomerular filtration rate: data from the United Kingdom Transplant registry – a retrospective cohort study

Clinical management of polycystic liver disease

Simultaneous liver kidney transplantation and (bilateral) nephrectomy through a midline is feasible and safe in polycystic disease

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