Better Outcomes for Combined Liver-Kidney Transplants

A new study shows that combined liver-kidney transplants appear to benefit patients with diseases in both organs, including patients with potentially reversible kidney failure who have been receiving dialysis for longer than two months.

Researchers from the David Geffen School of Medicine at the University of California Los Angeles (UCLA, USA) reviewed data from 98 patients who underwent 99 combined liver-kidney transplants between 1988 and 2004. The patients' average age was 46 years; 76 suffered from primary kidney diseases and 22 had hepatorenal syndrome. For comparison, the researchers also reviewed data from 148 patients with hepatorenal syndrome who underwent a liver transplant alone between 1998 and 2002 and 743 patients who received only a kidney transplant.

Of the 99 combined-transplant patients, 31 had died. The survival rates at one, three, and five years after surgery were 76%, 72%, and 70%, respectively. None of the risk factors analyzed by the researchers, including donor characteristics, recipient age, or previous transplants, influenced the patient's survival rate after surgery. Among those who underwent only kidney transplants, 23% of the kidneys were rejected by the recipient's body after one year, compared with 14% of those who had liver-kidney transplants. In hepatorenal syndrome patients, those undergoing dialysis for longer than two months before surgery recovered better after the combined transplant than patients who received only liver transplants. The study was published in the August 2006 issue of The Archives of Surgery.

"Our study indicates that a combined liver-kidney transplant is the procedure of choice for patients suffering end-stage disease in both the liver and kidneys,” said lead author Dr. Ronald Busuttil, professor and chair of surgery at UCLA. "For the first time, it also appears that a dual-organ transplant can help liver-disease patients with temporary kidney dysfunction.”

Hepatorenal syndrome--potentially reversible kidney failure caused by cirrhosis or another liver disease--is often treated by liver transplant alone, not a combined procedure. As waiting times for organs rise, however, hepatorenal-syndrome patients face an increased risk of developing a chronic, irreversible condition that may require a combination transplant.



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