Combined liver-kidney transplantation: What are the indications?

We have reviewed the literature, UNOS results, and our own experienced with combined LKTx. In studying the UNOS database, it is apparent that many LKTx are performed for a variety of indications for LKTx. The data from our center demonstrate that the presence of renal dysfunction does not indicate that a patient with liver failure should necessarily receive a combined LKTx, if they are managed with alternations in nephrotoxic immunosuppression, in order to minimize loss of renal function. However, UNOS data demonstrate that LTx patients with SCr>2.0 mg/dl faired poorly compared with LKTx patients, implying that patients with borderline renal function should be candidates for combined LKTx. The reasons for the disparity between the UNOS data and our data are no clear and may represent the interest and experience of our center alone. However, this issue warrants further study. We continue to believe, however, that cadaveric kidney transplants are a scarce resource which must be used judiciously. Although exact indications for combined LKTx are not yet clearly defined, primary oxaluria type I and polycystic liver and kidney disease may be two disease processed that appear to be adequately treated with combined LKTx.