Technologies et recherche en matière de transplantation

Clinical Decision-Making Dilemna: Liver alone or Simultaneous Liver-Kidney Transplantation?

Abstract

Phuong-Thu T. Pham and Phuong-Chi T. Pham

With the introduction of the MELD score for the allocation of orthotopic liver transplant (OLT) in February 2002, a striking 278% increase in the number of simultaneous liver-kidney transplants (SLKT) was observed during the 9-year period post-MELD when compared with the preceeding 9-year in the pre-MELD era (pre- vs.post-MELD era, n= 1049 vs. 2914, respectively) [1]. For OLT candidates with simultaneous end-stage kidney failure, SLKT is a well-established effective therapeutic option for virtually all suitable candidates.However, there have been no well-defined guidelines to determine whether a kidney transplant should be offered to OLT candidates who have chronic kidney disease (CKD) or prolonged acute kidney injury (AKI) secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) while awaiting a liver transplant. Specific challenges in the decision making process include the accurate assessment of the degree of existing renal dysfunction in those with CKD and the prediction of the extent of renal function recovery in those with AKI with or without underlying CKD.