[Renal graft outcome in patients with associated liver transplant].

Introduction: Nearly 50% of liver transplant recipients have some degree of renal failure; patients in haemodialysis treatment have a higher risk of suffering hepatic diseases related to viral infections or concomitant pathologies. Improvement in surgical and organ preservation techniques and immunosuppressive therapy has permitted multiorganic transplants in patients needing both liver and kidney organs.

Objectives: To review our results in renal transplants in those patients with liver and kidney transplants.

Material And Method: Retrospective study of the 15 patients with liver and kidney transplants performed in our Hospital. We have reviewed patients main characteristics, liver and renal failure causes, renal graft and patient outcome and complications relate to renal transplant.

Results: Between 1975 and December 2006 we performed 1483 kidney transplants and between 1991 and December 2006, 409 liver transplants. We performed multiorganic liver and kidney transplants to 15 patients (4 women and 11 men). The average for liver transplant recipients was 52.5+/-9.3 years (range 37-61) and for kidney transplant recipients was 51+/-12.5 years (35-66). Cold ischemia was 6.4+/-5.4 hours (6-8) in simultaneous liver-kidney transplant and 20.5+/-5.4 (8-27 hours) in non-simultaneous ones. Three patients had a renal transplant before the liver one (two functioning which had no changes after hepatic transplant but the other was lost due to IgA glomeruloneprhitis relapse and received a simultaneous kidney-liver transplant). Six patients received a simultaneous kidney-liver transplant and eight patients a renal transplant between 16 and 83 months (x=50.5+/-25.9 months) after the liver transplant. A renal graft was lost due to renal vein thrombosis and two due to IgA relapse; the others were functioning between 6 and 264 months of follow-up (x=92.5+/-66.7) with creatinine levels of 1.86+/-mg/100, (range 1-4.5). Four patients died due to hepatic failure between 8 months and 21 years after renal transplant and another died of oesophagus cancer 14 years after the kidney transplant, in all cases with functioning renal graft. There were no cases of kidney graft acute rejection in simultaneous transplants but there were five in non-simultaneous ones. Immunotherapy was based on steroids and tacrolimus.

Conclusions: Liver-kidney transplants are worthy options in patients with hepatic and renal end failure. Acute rejection seems to have fewer incidences in simultaneous liver-kidney transplantation.