Changes in liver allocation due to institution of the model for end-stage liver disease/PELD criteria have led to an increase in the number of patients receiving liver transplants who have elevated creatinine. Whether these patients' renal dysfunction is reversible or not and whether they should receive combined liver and kidney transplants (KTXs) are individualized decisions, although some criteria are becoming clearer. A part of this decision must consider the outcomes of patients who have liver transplants alone but later require KTXs. We herein describe our single-center experience with this patient population. Our data show that KTX subsequent to liver transplantation (TX) is generally safe and effective, with a possibly higher surgical complication rate than standard KTX. Outcomes analysis showed not statistically different patient survival of KTXs performed after liver transplant (KALT) compared with KTX alone. Death censored graft survival was statistically lower in the KALT group but this largely accrued in the first threeyr after transplant and was nearly equivalent by 10yr.
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