Abstract
Background and Aims
Most guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with liver cirrhosis (LC) and severe chronic kidney disease (CKD) over liver transplantation alone (LTA). CKD, however, is not irreversible. This study evaluates the reversibility of kidney disease after LTA based on kidney size.
Method
In this single-center retrospective study, we classified 90 patients with LC and severe CKD into 3 groups: normal kidney-LTA (NK-LTA, n=39), small kidney [both <9cm]-LTA (SK-LTA, n=40), and small kidney-SLKT (SK-SLKT, n=11). Baseline characteristics and renal recovery and survival outcomes were compared among 3 groups.
Results
The NK-LTA group had a lower percentage of hepatocellular carcinoma, a higher pre-LT eGFR, and a shorter duration of eGFR at <60 ml/min and pre-LT dialysis. This group, however, was older, received livers from a higher percentage of deceased donors and had a higher Child-Pugh score. Renal recovery, defined as no hemodialysis (HD) after LT, was found in 79% of those in the NK-LTA group, which was higher than 7.5% of those in the SK-LTA group. Renal survival, defined as patient survival without progression to HD or kidney transplant was found in 56% of patients in the NK-LTA group, which was higher than 2.5% of those of the SK-LTA group.
Conclusion
Patients with LC and severe CKD with normal kidney size may experience reversible kidney disease after LTA. Therefore, kidney after liver transplantation is recommended over SLKT for these patients.
Different Effects on Fluid Distribution between Tolvaptan and Furosemide in a Liver Cirrhosis Patient with Chronic Kidney Disease
