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P83 Combined liver and kidney transplantation: a single centre experience
  1. M Smith,
  2. K Rye,
  3. T Haldane,
  4. B Gunson,
  5. S Bramhall,
  6. D Mutimer
  1. Liver Unit, Queen Elizabeth Hospital Birmingham

Abstract

Introduction Combined liver kidney transplantation (CLKT) is an accepted approach to management of patients with dual organ pathology, but may be associated with significant additional post-operative morbidity and mortality in comparison with transplantation of either organ alone.

Aim To analyse the experience of CLKT at a single centre.

Method Retrospective analysis of all CLKTs performed at our centre between May 1994 and August 2010. Data collected included demographics, indications for CLKT, surgical techniques, post-transplant complications and patient/graft survival.

Results Of 2130 liver transplants (LT) performed there were 24 CLKTs—12 male with median age 52 years, Child-Pugh score 7 and MELD 19. Indications for LT were polycystic liver disease 11 (46%), cirrhosis 7 (29%), hepatocellular carcinoma 2 (8%), recurrent PSC/PBC 3 (12%), oxalosis 1 (4%). The indications for kidney transplantation (KT) were polycystic kidney disease 10 (42%), calcineurin-inhibitor toxicity 4 (17%), chronic kidney graft failure 4 (17%), IgA nephropathy 3 (13%), diabetes 1 (4%), Type II hyperoxaluria 1 (4%), glomerulonephritis 1 (4%). Five patients had prior KT; four chronic graft failure, 1 calcineurin-inhibitor toxicity. 12 patients (50%) were dialysis-dependent pre-transplantation.

During a median follow-up of 1223 days (IQR 550–2264 days) 5 patients died (overall survival 79.2%) with a median time from CLKT to death 947 days (range 4–2373 days). Causes of death: primary non-function of the liver (1), cardiac complications (2) and de novo cancer (2). Seven patients (29%) had at least one episode of histologically proven acute cellular rejection of the liver and 1 (4%) acute renal rejection.

Cumulative 1, 3 and 5-year patient, liver graft and kidney graft survival were 96%, 85%, 75%; 86%, 79%, 62% and 91%, 85%, 75% respectively. 3 patients required further liver transplantation (2 hepatic artery thrombosis, 1 primary non-function). 13 patients required haemodialysis post-operatively. At 3-month follow-up, survivors had median creatinine and eGFR of 129 μmol/l and 48 ml/min respectively; 1 patient still required dialysis. At 1 year and 5 years median creatinine and eGFR were 134 μmol/l and 43 ml/min, 155 μmol/l and 38 ml/min respectively. 1 patient resumed haemodialysis 4640 days after CLKT and is on the waiting list for renal re-transplantation.

Conclusion CLKT in this cohort had favourable outcomes with excellent patient and graft survival (both organs). Although the number of patients in our study is relatively few, 5-year kidney graft survival rates do not appear inferior to published data for patients undergoing renal transplantation alone.

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