HEPATORENAL-SYNDROME - COMBINED LIVER-KIDNEY TRANSPLANTS VERSUS ISOLATED LIVER-TRANSPLANT

Background. As many as 38% of combined liver-kidney transplant (LKTx) procedures performed nationally may be done for the renal diagnosis of hepatorenal syndrome (HRS). This study was designed to compare the na tional results with those at our medical center and to determine if co mbined LI(Tx provides any benefit over isolated liver transplant (LTx) to HRS patients. Methods. Data on 29 combined LKTx and 79 HRS patient s at our center were collected and compared with the national data on 414 LKTx and 2442 patients with serum creatinine >2.0 mg/dl receiving isolated LTx from 1988 to 1995. Results. United Network of Organ Shari ng data revealed B-year patient survival of 62.2% for LKTx recipients and 50.4% for patients with serum creatinine >2.0 mg/dl receiving isol ated LTx (P=0.0001). Our center results demonstrated 5-year patient su rvival of 48.1% for LKTx patients, 67.1% for HRS patients receiving is olated LTx, and 70.1% for patients with serum creatinine >2.0 mg/dl re ceiving isolated LTx (P not significant comparing all groups). Intensi ve care unit status and preoperative dialysis rates were similar in th ose HRS patients who did and Obese who did not need future I(Tx. Concl usion. National data would suggest a survival benefit of combined LKTx over isolated LTx for those patients with poor renal function, specif ically those with HRS, whereas our center's results suggest otherwise. Unfortunately, we could not identify any preoperative risk factors in the HRS patients, or in the broader group of patients with renal insu fficiency at our center, that would indicate the need for future renal transplantation. We believe that HRS patients can be successfully man aged with isolated LTx.