New UCLA research shows that combined liver-kidney transplants appear to benefit patients with diseases in both organs, including patients with potentially reversible kidney failure who have been receiving dialysis for longer than two months. The Archives of Surgery will publish the findings in its August issue.
"Our study indicates that a combined liver-kidney transplant is the procedure of choice for patients suffering end-stage disease in both the liver and kidneys," explained Dr. Ronald Busuttil, professor and chair of surgery at the David Geffen School of Medicine at UCLA. "For the first time, it also appears that a dual-organ transplant can help liver-disease patients with temporary kidney dysfunction."
Hepatorenal syndrome -- potentially reversible kidney failure caused by cirrhosis or another liver disease -- is often treated by liver transplant alone, not a combined procedure. As waiting times for organs rise, however, hepatorenal-syndrome patients face an increased risk of developing a chronic, irreversible condition that may require a combination transplant.
Busuttil and his colleagues reviewed data from 98 patients who underwent 99 combined liver-kidney transplants at the Dumont-UCLA Transplant Center in the Pfleger Liver Institute from 1988 to 2004. The patients' average age was 46 years; 76 suffered from primary kidney diseases and 22 had hepatorenal syndrome.
For comparison, the researchers also reviewed data from 148 patients with hepatorenal syndrome who underwent only a liver transplant between 1998 and 2002, and 743 patients who received only a kidney transplant.
Of the 99 combined-transplant patients, 31 had died. The survival rates at one, three and five years after surgery were 76, 72 and 70 percent, respectively. None of the risk factors analyzed by the UCLA team, including donor characteristics, recipient age or previous transplants, influenced the patient's survival rate after surgery.
A review of organ survival rates in combination-transplant patients showed that 70 percent of the transplanted livers and 76 percent of the transplanted kidneys survived after one year. After three years, 65 percent of the livers and 72 percent of the kidneys survived; and after five years, 65 percent of the livers and 70 percent of the kidneys survived.
Among those who underwent only kidney transplants, 23 percent of the kidneys were rejected by the recipient's body after one year, compared with 14 percent of those who had liver-kidney transplants.
In hepatorenal syndrome patients, those undergoing dialysis -- the use of a machine to perform the blood filtration normally handled by the kidneys -- for longer than two months before surgery recovered better after the combined transplant than patients who received only liver transplants.
"We used to recommend combined liver-kidney transplantation when patients received dialysis for longer than one month before transplantation," said Busuttil. "Based on our current findings, however, we found that the acuteness of renal failure subsided after two months of dialysis. A combined transplant after this time will improve patient survival and also reduce hospital expenditures for patient care.
"Our evaluation shows that combined kidney-liver transplantation performed at a high-volume academic transplant center offers the best option for patients with simultaneous chronic liver and kidney failure," he concluded.
Busuttil's coauthors at UCLA included Dr. Hiroko Kunitake, Dr. Alan Wilkinson, Dr. Gabriel Danovitch, Dr. Douglas Farmer, Dr. R. Mark Ghobrial, Dr. Hasan Yersiz, Dr. Jonathan Hiatt, and Dr. Richard Ruiz, now of Baylor University in Dallas. The research was supported by the Dumont Foundation and George T. Pfleger Foundation.
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