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Experience of combined liver-kidney transplantation for acute-on-chronic liver failure patients with renal dysfunction.
- Source :
-
Transplantation proceedings [Transplant Proc] 2013 Jul-Aug; Vol. 45 (6), pp. 2307-13. Date of Electronic Publication: 2013 Jul 17. - Publication Year :
- 2013
-
Abstract
- Background: The aim of this study was to evaluate the outcomes of orthotopic liver transplantation (OLT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction.<br />Methods: From January 2001 to December 2009, 133 patients underwent OLT for ACLF at our center. Among them, 30 had both ACLF and renal dysfunction. Of the 30 patients, 12 underwent CLKT for end-stage renal disease (ESRD), and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent OLT alone. ACLF was defined according to the Asian Pacific Association for the Study of Liver Consensus Meeting. Clinical data were reviewed for survival outcomes.<br />Results: The median model for end-stage liver disease score (MELD) of patients with ACLF was 28. Among the 133 patients, all of whom received deceased donor liver grafts, 12 also got the kidney grafts from the same deceased donor. The hospital mortality rate was 21.8% for all patients with ACLF. The 5-year survival rates were 72.8% for patients without renal dysfunction and 70% for patients with renal dysfunction. The results of patients with ESRD who underwent CLKT were better than those of subjects without renal dysfunction or patients with HRS1 who underwent OLT alone.<br />Conclusions: OLT alone improved renal function in most patients with HRS1, including those requiring short-term hemodialysis. Simultaneous liver-kidney transplantation was an excellent strategy for patients with both ACLF and ESRD. It provided protection to the kidney allograft for liver-based metabolic diseases affecting the kidney. The rate of acute rejection episodes in kidneys was low.<br /> (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Disease
Adolescent
Adult
Chi-Square Distribution
End Stage Liver Disease diagnosis
End Stage Liver Disease mortality
Female
Graft Rejection etiology
Hepatorenal Syndrome diagnosis
Hepatorenal Syndrome mortality
Hospital Mortality
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic diagnosis
Kidney Failure, Chronic mortality
Liver Failure, Acute diagnosis
Liver Failure, Acute mortality
Male
Middle Aged
Risk Factors
Time Factors
Treatment Outcome
Young Adult
End Stage Liver Disease surgery
Hepatorenal Syndrome surgery
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Kidney Transplantation mortality
Liver Failure, Acute surgery
Liver Transplantation adverse effects
Liver Transplantation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1873-2623
- Volume :
- 45
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Transplantation proceedings
- Publication Type :
- Academic Journal
- Accession number :
- 23871182
- Full Text :
- https://doi.org/10.1016/j.transproceed.2013.02.127