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Updated: Jun 13, 2026
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Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Combined liver and kidney transplantation
Haris Papafragkakis1, Paul Martin, Enver Akalin
1Division of Hepatology, University of Miami, Miami, Florida, USA.
Current Opinion in Organ Transplantation
|April 14, 2010
Summary
Combined liver and kidney transplantation (CLKT) has increased since the Model for End-Stage Liver Disease (MELD) system implementation. Differentiating hepatorenal syndrome from chronic kidney disease is crucial for selecting appropriate CLKT candidates.
Area of Science:
- Transplantation Medicine
- Nephrology
- Hepatology
Background:
- The Model for End-Stage Liver Disease (MELD) scoring system, implemented in 2002, has led to a significant rise in combined liver and kidney transplantations (CLKTs) in the USA.
- Consensus conferences in 2006 and 2007 aimed to standardize the evaluation and selection of CLKT candidates.
Purpose of the Study:
- To review studies on CLKT, focusing on 2008-2009 publications.
- To assess the impact of the MELD system and consensus conferences on CLKT candidate selection.
Main Methods:
- Literature review of studies on combined liver and kidney transplantation.
- Analysis of publications from 2008 and 2009.
Main Results:
- Differentiating hepatorenal syndrome from nonreversible chronic kidney disease remains challenging for CLKT candidate selection.
- Renal biopsies can aid in decision-making for CLKT.
- Patients with glomerular filtration rate <30 ml/min, hepatorenal syndrome requiring >8-12 weeks of renal replacement therapy, or >30% renal fibrosis/glomerulosclerosis benefit from CLKT.
Conclusions:
- Organ allocation must prioritize patients in genuine need, especially given organ shortages.
- Orthotopic liver transplantation alone significantly reduces survival for patients with advanced renal disease.
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