Combined liver-kidney transplant beneficial for patients with dual organ disease

Combined liver and kidney transplant appears to benefit patients with diseases in both organs, including those with a condition known as hepatorenal syndrome who have been receiving dialysis for more than two months, according to an article in the August issue of Archives of Surgery, one of the JAMA/Archives journals.

A combined liver and kidney transplant is the procedure of choice for patients with both end-stage liver disease and end-stage renal (kidney) disease, according to background information in the article. However, the decision is more complicated in cases when kidney dysfunction may be temporary. Currently, hepatorenal syndrome--potentially reversible kidney failure combined with cirrhosis or another liver disease--is often treated with liver transplant alone and not a combined procedure. As waiting times for organs increase, more patients with hepatorenal syndrome will likely develop a chronic, irreversible condition that may require a combination transplant.

Richard Ruiz, M.D., and colleagues at the University of California, Los Angeles, reviewed data from 98 patients who underwent 99 combined liver and kidney transplants at one academic medical facility during a 16-year period, from 1988 to 2004. The patients had an average age of 46 years; 76 had 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 kidney transplants alone.

Of the 99 combined transplant patients, 31 had died at the end of the analysis. One-, three-, and five-year survival rates were 76, 72 and 70 percent. None of the risk factors analyzed by the researchers, including characteristics of the donor, age of the recipient or previous transplants affected whether or not the patients would die after surgery. In dual transplant patients, 70 percent of the transpla

Contact: Elaine Schmidt
JAMA and Archives Journals

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