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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Simultaneous Liver-Kidney Transplantation.

Vichin Puri1, James Eason1

  • 1Methodist/University of Tennessee Transplant Institute, 1211 Union Ave. Suite 340, Memphis, TN 38104 USA.

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|November 3, 2015
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Summary

Simultaneous liver-kidney transplants (SLK) have increased significantly since 1990, rising to 8.2% in 2014. Advances in medicine and ethical considerations are shaping the future of this complex procedure.

Keywords:
Combined liver-kidney transplantKidney transplantLiver transplantMELD scoreMulti-organ transplantOPTNSimultaneous liver-kidney transplant

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Area of Science:

  • Organ transplantation research
  • Nephrology and Hepatology
  • Transplant ethics

Background:

  • Simultaneous liver-kidney transplants (SLK) have seen a notable increase, representing 8.2% of US liver transplants in 2014, up from 1.7% in 1990.
  • The evolution of the Model for End-Stage Liver Disease (MELD) system has influenced patient selection for SLK.
  • Organ scarcity presents ongoing ethical challenges for transplant centers regarding SLK allocation.

Approach:

  • Review of advancements in immunosuppression protocols and treatments for Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) impacting SLK.
  • Analysis of simulation modeling to predict the future implications of current transplant decisions.
  • Exploration of Donation after Circulatory Death (DCD) protocols in the context of SLK.

Key Points:

  • The increasing prevalence of SLK highlights evolving transplant practices and criteria.
  • Improvements in medical treatments and immunosuppression have broadened the scope of SLK candidacy.
  • Ethical frameworks and resource allocation models are critical in managing the demand for SLK.

Conclusions:

  • SLK procedures have become more prevalent due to medical advancements and changing allocation systems.
  • Future perspectives on SLK are continuously shaped by ongoing research, technological progress, and ethical deliberations.
  • This review synthesizes studies demonstrating the success and evolving landscape of simultaneous liver-kidney transplantation.