A Novel Approach in Combined Liver and Kidney Transplantation With Long-Term Outcomes
In the first meta-analysis examining the role of HMPO2 in kidney transplantation finds it may lower adverse events, particularly in DCD cases.
Background
The aim of this study was to compare the outcomes of simultaneous and delayed implantation of kidney grafts in combined liver-kidney transplantation (CLKT).
Liver allocation according to the model for end-stage liver disease (MELD) system was introduced in 2002. As a direct consequence, there was a rapid increase in the yearly number of combined liver-kidney transplants (CLKTs), as patients with renal failure had a consistently high MELD score.1 As many as 30% of liver transplant (LT) patients have renal insufficiency at the time of transplant, contributing significantly to their overall MELD score.1,2 The selection of candidates for CLKT, however, is complex because renal disease associated with liver failure may be acute or chronic in nature. As a consequence, there is no well-defined allocation policy for patients listed for CLKT.3,4 Despite ‘‘proposed’’ listing criteria for CLKT, several transplant centers use more liberal selection criteria to minimize post-LT kidney failure.5,6 Nadim et al7 conducted a survey of 88 transplant centers that perform CLKT in the United States to determine practice patterns. The majority of centers in this study (73%) used dialysis duration for acute renal failure as a cutoff for CLKT listing, with duration varying between >4 and >8 weeks. There were 30% of centers that used any acute kidney injury alone as adequate criterion for determining the need for CLKT.7