Simultaneous Liver-Kidney Transplantation for Adult Recipients With Irreversible End-Stage Renal Disease

Moreno‐González, E.; Meneu-Diaz, J.C.; García, Ignacio; Cerdá, F. Pérez; Abradelo, M.; Jiménez, Carlos; Loinaz, Carmelo; Gómez, R; Gimeno, Antonio Martínez; Moreno, A.

doi:10.1001/archsurg.139.11.1189

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…SLK transplantation thus emerged as an option for avoiding the deleterious effects of dialysis in the posttransplant period. However, early results demonstrated that SLK transplantation was associated with higher rates of operative mortality and morbidity compared with LT alone, making it imperative to clearly distinguish patients with reversible renal failure from those patients with advanced, irreversible renal failure (16). Multiple studies performed in the pre-MELD era concluded that severity of pretransplant renal failure as opposed to causative factors was more predictive of long-term renal dysfunction (8,(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies performed in the pre-MELD era concluded that severity of pretransplant renal failure as opposed to causative factors was more predictive of long-term renal dysfunction (8,(17)(18)(19)(20). Before the introduction of the MELD allocation system, the general consensus among the transplant community was that only those liver failure patients with fixed renal disease requiring dialysis for more than 4 weeks should undergo SLK transplantation (8), and as a result appropriately selected SLK recipients were shown to have outcomes similar to patients with intact renal function who underwent LT alone (16). Therefore, before 2002, usage of renal allografts in the context of SLK had been justified by excellent outcomes, and the frequency of SLK had remained low at approximately 100 procedures per year (21).…”

Section: Discussionmentioning

confidence: 99%

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Declining Outcomes in Simultaneous Liver-Kidney Transplantation in the MELD Era: Ineffective Usage of Renal Allografts

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Declining Outcomes in Simultaneous Liver-Kidney Transplantation in the MELD Era: Ineffective Usage of Renal Allografts

et al. 2008

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“…SLK remains to be the ideal treatment option for patients with decompensated cirrhosis and end-stage renal disease (ESRD) 6, 76, 8 as the reported survival is similar to liver transplant alone (LTA) recipients without renal dysfunction. However, the recommended SLK criteria do not provide clear guidelines concerning transplant recipients with acute kidney injury (AKI) requiring renal replacement therapy (RRT < 3 months) and AKI superimposed on chronic kidney disease (CKD).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

Tanrıöver

MacConmara

Parekh

et al. 2016

Kidney International Reports

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Background The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK transplant survival has not been well described in the literature. Methods The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N=2,700) or SLK (N=1,361) transplantation with moderate renal insufficiency between 2003 and 2013. The study cohort was stratified into four groups based on serum creatinine (Scr< 2 mg/dL versus Scr≥ 2 mg/dL) and dialysis status at listing and at transplant. The patients with end-stage renal disease and requiring acute dialysis more than three months before transplantation were excluded. A propensity score (PS)-matching was performed in each stratified groups to factor out imbalances between the SLK and LTA regarding covariates distribution and to reduce measured confounding. Donor quality was assessed with liver-donor risk index (L-DRI). The primary outcome of interest was post-transplant mortality. Results On multivariable PS-matched Cox proportional hazard models, SLK led to decrease in post-transplant mortality compared to LTA across all four groups, but only reached statistical significance (HR 0.77; 95% CI, 0.62–0.96) in the recipients not exposed to dialysis and Scr≥ 2 mg/dL at transplant (mortality incidence rate per patient-year 5.7% in SLK vs. 7.6% in LTA, p=0.005). The decrease in mortality was observed among SLK recipients with better quality donors (L-DRI<1.5). Conclusions Exposure to pre-transplantation dialysis and donor quality affected overall survival among SLK recipients.

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“…This is thought to be because of the immune protection provided by the liver graft (72,73). HCV-infected kidney transplant recipients were reported to have higher post-transplant mortality and lower renal graft survival (74).…”

Section: Renal Failure and Hcv Treatment During The Transplant Periodmentioning

confidence: 99%

New modalities in the treatment of HCV in pre and post - transplantation setting

Araz

Durand²,

Gürakar³

2015

Turk J Gastroenterol

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End-stage liver disease and hepatocellular carcinoma (HCC) secondary to hepatitis C virus (HCV) infection are the leading indications for liver transplantation (LT) in developed countries. Recurrence of HCV following LT is universal if the recipient has detectable serum HCV RNA at the time of LT. Recurrent HCV has an accelerated course and is associated with poor long term patient and graft survival. Interferon (IFN)-based regimens have achieved low Sustained Virological Rates (SVR) in this setting and are associated with a high rate of adverse events, resulting in treatment discontinuation. With advances in understanding the HCV life cycle, drugs targeting specific steps, particularly inhibiting the NS3/4A protease, NS5B RNA dependent RNA polymerase and the NS5A protein, have been developed. Sofosbuvir (SOF), a nucleotide analogue inhibitor of NS5B polymerase was the first compound to enter the market. Combinations of SOF with new HCV antivirals from other classes have allowed for IFN-free regimens with low rates of adverse events and SVR rates >90%. With the availability of newer agents, the approach to the treatment of HCV infection during the pre-and post-liver transplantation period has changed. We will hereby review the current status of HCV treatment and discuss the potential future therapies in the transplant setting.

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Simultaneous Liver-Kidney Transplantation for Adult Recipients With Irreversible End-Stage Renal Disease

Cited by 17 publications

References 26 publications

Declining Outcomes in Simultaneous Liver-Kidney Transplantation in the MELD Era: Ineffective Usage of Renal Allografts

Declining Outcomes in Simultaneous Liver-Kidney Transplantation in the MELD Era: Ineffective Usage of Renal Allografts

Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

New modalities in the treatment of HCV in pre and post - transplantation setting

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