Combined liver-kidney transplantation: experience at Bologna's transplant center

The results obtained for combined liver-kidney transplantation (CLKT) are reported.

From 1997 to 2003 six procedures were performed in patients with polycystic disease (n = 2), chronic glomerulonephritis associated with HCV cirrhosis (n = 2), chronic interstitial nephritis associated with cirrhosis HCV + alcohol (n = 1), and subacute hepatitis caused by drugs (n = 1). The average age of patients was 55 years (5 M and 1 F). The liver transplants were performed using the piggyback technique except in the two polycystic patients, for whom a conventional technique was used. The immunosuppressive therapy was based on cyclosporine in five patients and tacrolimus in one patient.

The average blood transfusion was 3670 mL, with larger consumption in the two polycystic cases. Graft function immediately after operation was satisfactory. There were two cases of liver and kidney rejection. In one case, a cardiac arrest occurred during the operation with neurologic consequences. The postoperative complications were cyclosporine neurotoxicity (n = 1), pleuric empyema treated with surgical drainage (n = 1), and CMV infection (n = 1). Four years after CLKT, one patient underwent nephrectomy for a de novo tumor. Of the six patients, four are in good general condition whereas the two polycystic disease patients died within 1 month from transplantation due to ARDS and MOF, respectively.

Based on the worst results of CLKT occurred among patients with polycystic disease, a more rigorous selection is necessary.