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Renal function outcomes following liver transplantation and combined liver–kidney transplantation

Nature Clinical Practice Nephrology volume 3, pages 507–514 (2007)Cite this article

Abstract

Acute renal failure (ARF) is common immediately after orthotopic liver transplantation (OLT), whereas the incidences of chronic kidney disease (CKD) and end-stage renal disease increase with time. Introduction of the Model for End-stage Liver Disease (MELD) score—intended to prioritize patients with more-severe pretransplantation liver disease in general, and worse pretransplantation renal function in particular—for the allocation of liver grafts led to concerns about compromised patient and allograft survival and increased incidence of postoperative ARF and CKD. Nonetheless, it has been suggested that early OLT of candidates with baseline renal dysfunction improves post-transplantation renal outcomes. For OLT candidates with mild to moderate chronic renal impairment or recent-onset ARF, the decision of whether to perform OLT alone or combined liver–kidney transplantation (CLKT) can be challenging because no single factor has been shown to be predictive of the degree of renal function recovery or CKD progression following successful OLT. In this article, we provide an overview of the literature on renal function outcomes following OLT and CLKT, share our perspectives on the potential predictors of renal dysfunction or nonrecovery of renal function after OLT, and present United Network for Organ Sharing data on patient and allograft outcomes in CLKT recipients in the pre-MELD and post-MELD eras. Mechanisms that might underlie immunological protection of kidney grafts by liver allografts are also discussed.

Key Points

  • Studies of renal function after orthotopic liver transplantation (OLT) have yielded conflicting results, and there is a paucity of data on renal outcomes after combined liver–kidney transplantation (CLKT)

  • The Model for End-stage Liver Disease (MELD) score, introduced in February 2002 for allocation of organs available for OLT, prioritizes patients with more-severe pretransplantation liver disease in general, and worse pretransplantation renal function in particular

  • More CLKTs have been performed, in both absolute and relative terms, since the introduction of the MELD score

  • Evidence indicates that liver allografts have an immunoprotective effect on kidney allografts from the same donor when the organs are transplanted together

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Figure 1: Survival of patients who underwent combined liver–kidney transplantation between 2000 and 2004
Figure 2: Survival of kidney grafts transplanted during combined liver–kidney transplantation between 2000 and 2004
Figure 3: Survival of liver grafts transplanted during combined liver–kidney transplantation between 2000 and 2004

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Acknowledgements

We are indebted to Ms Katarina Anderson for providing the OPTN/UNOS data. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

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Authors and Affiliations

  1. P-TT Pham is Associate Professor of Medicine, and Director of Outpatient Services at the David Geffen School of Medicine, Los Angeles ,

    Phuong-Thu T Pham

  2. P-CT Pham is Associate Professor of Medicine at Olive View–UCLA Medical Center, Sylmar ,

    Phuong-Chi T Pham

  3. AH Wilkinson is Professor of Medicine and Director of the Kidney and Pancreas Transplant Program, at the University of California, Los Angeles, CA, USA.,

    Alan H Wilkinson

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  1. Phuong-Thu T Pham
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Correspondence to Alan H Wilkinson.

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Pham, PT., Pham, PC. & Wilkinson, A. Renal function outcomes following liver transplantation and combined liver–kidney transplantation. Nat Rev Nephrol 3, 507–514 (2007). https://doi.org/10.1038/ncpneph0574

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