Simultaneous liver and kidney transplantation:analysis of a single-center experience

Background Simultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment forcombined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poorgeneral condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalanceand acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience,prevention and treatment of postoperative complications of SLKT.Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University fromJanuary 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperativefluid management, immunosuppressive regimen and experience in prevention and treatment of postoperativecomplications were analyzed.Results All operations were successfully performed. Postoperative complications occurred in 13 cases (59.1%),including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinalbleeding (1), and acute liver graft rejection (1). All complications were treated conservatively. In this study, there were fivedeaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 monthswas 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively.Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage torenal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and morepostoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, theanatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management,reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve thelong-term patient survival after SLKT.