Simultaneous liver kidney transplantation

Abstract

Summary Kidney injury is frequently seen in patients with end‐stage liver disease from cirrhosis and liver failure. Among selected patients, simultaneous liver kidney (SLK) transplantation provides improved post‐transplant graft and patient outcomes compared to liver transplantation (LT) alone. We conducted the review of the existing literature on SLK transplant criteria and outcomes. Since the introduction of the model for end‐stage disease (MELD) score in 2002, there has been an increased use of SLK transplantation. The criteria for SLK allocation are relatively homogeneous among patients with end‐stage renal disease with cirrhosis and among patients with cirrhosis and chronic kidney disease. However, these are quite heterogeneous among patients with cirrhosis and acute kidney injury (AKI), mainly because of inability to accurately differentiate cause of AKI, especially hepatorenal syndrome versus intrarenal aetiology. Clearly, there is an unmet need of urine biomarkers of tubular injury and/or clinical models to accurately stratify AKI aetiology and to predict renal recovery after LT as basis to best utilize the scarce donor kidney pool. In this regard, it remains to be seen whether recently implemented policies by the organ procurement transplant network can fulfil the goal of saving donor kidneys and optimal allocation of SLK.

Editorial: when cirrhosis deserves haemodialysis—rethinking strategies. Authors’ reply

“…Thus, strict screening of hepatocellular carcinoma and evaluation of liver function are crucial in kidney recipients with compensated cirrhosis . Conversely, 5‐year survival of patients who underwent SLKT is around 70%–75% . We agree that specific survival data of haemodialysis patients with compensated cirrhosis classified as stage 1 (absence of portal hypertension) are still lacking in previous studies including our two recent .…”

Outcomes of en bloc simultaneous liver-kidney transplantation compared to the traditional technique

“…Renal insufficiency results in increased morbidity and mortality after liver transplantation . The utilization of simultaneous liver‐kidney transplantation (SLKT) mitigates the risks of renal failure in liver transplant candidates who have significant concurrent renal dysfunction . Over the past decade, SLKT has become more common, comprising 2.5% of all liver transplants in 2001 and increasing to 8.2% in 2014 .…”

Multidisciplinary Approach for Liver Transplantation in Patients with Nonalcoholic Steatohepatitis: It Takes a Village

“…69 Patients with ESLD from cirrhosis and liver failure are at a risk of developing kidney injury. 70 Patients who have ESLD from NAFLD are at even a higher risk of kidney injury. Given that NAFLD and CKD share many underlying risk factors, it is unsurprising that the two conditions are closely associated with one another.…”