THE LIVER NEITHER PROTECTS THE KIDNEY FROM REJECTION NOR IMPROVES KIDNEY GRAFT-SURVIVAL AFTER COMBINED LIVER AND KIDNEY-TRANSPLANTATION FROM THE SAME DONOR

It has been proposed that the liver protects a simultaneously transpla nted kidney from acute rejection. Using the United Network for Organ S haring database, we compared the kidney allograft data from 248 combin ed liver and kidney transplants (LKT) with a control group comprising 206 contralateral kidney alone transplants (KAT) from the same donor, The LKT and KAT groups were identical with respect to most baseline pa rameters, save a greater degree of HLA matching in the KAT group. The overall 3-year graft survival rate was higher in the KAT group compare d with the LKT group (80% vs 68%, P<0.01). When these data were censor ed to remove death as a cause of graft loss and to minimize the matchi ng effect, the 3-year survival rates were not statistically different (78% for KAT and 81% for LKT, P=NS). We conclude that the liver neithe r protects the kidney from rejection nor improves kidney allograft fun ction or survival after LKT.