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Simultaneous Liver-Kidney Transplantation: What are Our Obligations to the Kidney Only Recipient?

  • Kidney Transplantation (M Henry, Section Editor)
  • Published:
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Abstract

Purpose of Review

There has been a recent explosion in the number of simultaneous liver and kidney (SLK) transplants performed. This practice is crowding out the population of ESRD patients waiting for a kidney transplant.

Recent Findings

It has been alleged from retrospective, anecdotal reports, often from voluntary registries, that there is a survival advantage for those with renal dysfunction that receive an SLK compared to Liver Transplant Alone. However, this survival advantage is quite small—about 5% at 1 and 5 years at best. A new algorithm introduced in 2016 by UNOS may make this problem worse by allowing SLK transplant for patients who may not have permanent kidney failure with a glomerular filtration rate (GFR) as high as 30cm3/min.

Summary

The transplant community needs to have a high degree of vigilance to identify which groups of patients are being disadvantaged when reallocation schemes are created to direct organs from one group to another.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Bloom RD, Reese PP. Chronic kidney disease after nonrenal solid-organ transplantation. J Am Soc Nephrol. 2007;18:3031–41. Highlights the increasing number of non-renal organ transplant recipients experiencing CKD and ESRD after their transplant

    Article  CAS  PubMed  Google Scholar 

  2. Burra P, Senzolo M, Masier A, et al. Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study. Dig Liver Dis. 2009;41:350–6.

    Article  CAS  PubMed  Google Scholar 

  3. Gines A, Escorsell A, Gines P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology. 1993;105:229–36.

    Article  CAS  PubMed  Google Scholar 

  4. Ruebner R, GoldbergD APL, Bahirwani R, Levine M, Sawinski D, Bloom RD. Reese PP: Risk of end-stage renal disease among liver transplant recipients with pretransplant renal dysfunction. Am J Transplant. 2012;12:2958–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Parajuli S, Foley D, Djamali A, Mandelbrot D. Renal function and transplantation in liver disease. Transplantation. 2015;99:1756–64.

    Article  CAS  PubMed  Google Scholar 

  6. • Thompson JA, Lake JR. The impact of MELD allocation on simultaneous liver-kidney transplantation. Curr Gastroenterol Rep. 2009;11:76–82. Highlights the direct association of exploding rates of SLK transplant to the use of the MELD score that is dependent on GFR

    Article  PubMed  Google Scholar 

  7. Gonwa TA, McBride MA, Anderson K, Mai ML, Wadei H, Ahsan N. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am J Transplant. 2006;6:2651–9.

    Article  CAS  PubMed  Google Scholar 

  8. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_08

  9. http://www.srtr.org/reports-tools/srtroptn-annual-data-report. Accessed January 15, 2017.

  10. OPTN/UNOS Annual Report 2015. Am J Transplant. 2017;17:21–116.

    Article  Google Scholar 

  11. • Formica RN, Aeder M, Boyle G, et al. Simultaneous liver-kidney allocation policy: a proposal to optimize appropriate utilization of scarce resources. Am J Transplant 2016; 16: 758–766. The background behind the new UNOS allocation policy for simultaneous liver-kidney transplantation. Many of the problems with this policy are discussed in this paper.

  12. Fong TL, Khemichian S, Shah T, Hutchinson IV, Cho YW. Combined liver-kidney transplantation is preferable to liver transplant alone for cirrhotic patients with renal failure. Transplantation. 2012;94:411–6.

    Article  CAS  PubMed  Google Scholar 

  13. Renal replacement therapy in acute kidney injury: controversy and consensus. Crit Care. 2015;19:146–56.

  14. • Israni AK, Xiong H, Liu J, Salkowski N, Trotter JF, Snyder JJ, Kasiske BL. Predicting end-stage renal disease after liver transplant. Am J Transplant. 2013;13:1782–92. Important assessment that highlights the low rate of ESRD in liver alone recipients not on dialysis with low GFR at time of transplant. A workable prediction tool

    Article  CAS  PubMed  Google Scholar 

  15. Wadei HM, Gonwa TA, Taner CB. Simultaneous liver kidney transplant (SLK) allocation policy change proposal: is it really a smart move? Am J Transplant. 2016;16:2763–4.

    Article  CAS  PubMed  Google Scholar 

  16. Beben T, Rifkin DE. GFR estimating equations and liver disease. Adv Chronic Kidney Dis. 2015;22:337–42.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sherman DS, Fish DN, Teitelbaum I. Assessing renal function in cirrhotic patients: problems and pitfalls. Am J Kidney Dis. 2003;41:269–78.

    Article  CAS  PubMed  Google Scholar 

  18. Francoz C, Nadim MK, Baron A, et al. Glomerular filtration rate equations for liver-kidney transplantation in patients with cirrhosis: validation of current recommendations. Hepatology. 2014;59:1514–21.

    Article  PubMed  Google Scholar 

  19. Fallahzadeh MK, Singh N. The 24 hour urine creatinine clearance for prediction of glomerular filtration rate in liver cirrhosis patients: have we considered all elements? Hepat Mon. 2013;13(7):e13398.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Poge U, Gerhardt T, Stoffel B, et al. Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients. Nephrol Dial Transpl. 2006;21:660–4.

    Article  CAS  Google Scholar 

  21. • Orlando R, Mussap M, Plebani M, et al. Diagnostic value of plasma cystatin C as a GFR marker in decompensated liver cirrhosis. Clin Chemistry. 2002;48:850–8. Scientific basis for using Cystatin C as an endogenous marker for GFR in patients with decompensated liver cirrhosis

    CAS  Google Scholar 

  22. • Levitsky J, Baker T, Ahya SN, Levin ML, et al. Outcomes and native renal recovery following simultaneous liver-kidney transplantation. Am J Transplant. 2012;12:2949–57. Important study pointing out the large number of recipients with recovered native kidney function after SLK transplantation

    Article  CAS  PubMed  Google Scholar 

  23. Chopra B, Sureshkumar KK. Changing organ allocation policy for kidney transplantation in the United States. World J Transplant. 2015;5:38–43. 14

    PubMed  PubMed Central  Google Scholar 

  24. • Choudhury RA, Reese PP, Goldberg DS, Bloom RD, Sawinski DL, Abt PL. A paired kidney analysis of multiorgan transplantation: implications for allograft survival. Transplantation. 2017;101(2):368–76. Direct comparative study where one kidney from same donor went to a kidney alone recipient and one to an SLK recipient. At 5 years kidney-alone survival 15% greater than SLK

    Article  PubMed  Google Scholar 

  25. • Lunsford KE, Bodzin AS, Markovic D, et al. Avoiding futility in simultaneous liver-kidney transplantation: analysis of 331 consecutive patients listed for dual organ replacement. Annals surgery. 2016; doi:10.1097/SLA.0000000000001801. Sobering report on the continued practice of futile SLK transplants that have until now been excluded from Program Specific Reports by UNOS

    Google Scholar 

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine, Cleveland, USA

    Stuart M. Flechner

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  1. Stuart M. Flechner
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Correspondence to Stuart M. Flechner.

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Conflict of Interest

Stuart Flechner reports grants from Novartis Pharma outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Kidney Transplantation

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Flechner, S.M. Simultaneous Liver-Kidney Transplantation: What are Our Obligations to the Kidney Only Recipient?. Curr Transpl Rep 4, 110–115 (2017). https://doi.org/10.1007/s40472-017-0150-0

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  • DOI: https://doi.org/10.1007/s40472-017-0150-0

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