Single-center experience of combined liver and kidney transplantation.

Kidney or liver transplantation (KTx, LTx) today is a standard therapeutic procedure if one of these organs fails. However, the need for transplantation of both organs may arise with deterioration of organ function. To evaluate the success of combined LTx/KTx we analyzed 20 patients (aged 14-64) who received a total of 21 LTx and 31 KTx. Simultaneous LTx/KTx was performed in 14 patients, of whom 5 required further replacement of one or the other of the grafted organs. Six patients had sequential transplantation: 3 had LTx prior to the KTx, and 3 KTx prior to LTx. In 12 patients the indication for LTx was end-stage liver cirrhosis, and of these 8 died after LTx, mostly of infections. In a group of 8 transplant recipients without liver cirrhosis (e.g. polycystic liver), only 1 patient died. Eleven of the 20 grafted patients are still alive now (follow-up after LTx 14-120 months). Episodes of liver and kidney rejection occurred in only 30% and 15% of transplanted patients respectively. Only 1 patient is back on hemodialysis, the others have normal liver and kidney function. Combined LTx/KTx may be successful in appropriate circumstances. However, patients with liver cirrhosis have a very poor prognosis due to their poor overall clinical state at the time of terminal renal failure. In contrast, patients without liver cirrhosis are better candidates, even for simultaneous LTx/KTx. In general, the indication for simultaneous organ transplantation should be considered earlier than for transplantation involving only one organ.