The Conundrum of Patients With Compensated Cirrhosis Requiring Kidney Transplantation; Kidney Alone or Simultaneous Liver Kidney Transplantation.

Autor:	Dodge JL; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA.; Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA., Lee BT; Division of Gastroenterology, Department of Medicine, Loma Linda University Health, Loma Linda, CA., Kassem ACZ; Division of Hepatology, Baylor University Medical Center, Dallas, TX., Biggins SW; Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA., Rana PA; Division of Gastroenterology, Department of Medicine, Loma Linda University Health, Loma Linda, CA., Nadim MK; Division of Nephrology and Hypertension, Keck School of Medicine, University of Southern California, Los Angeles, CA., Asrani SK; Division of Hepatology, Baylor University Medical Center, Dallas, TX., Fong TL; Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA.; Liver Program, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2023 Feb 01; Vol. 107 (2), pp. 429-437. Date of Electronic Publication: 2022 Sep 26.
DOI:	10.1097/TP.0000000000004311
Abstrakt:	Background: Patients with compensated cirrhosis and chronic kidney disease are increasing along with demand for simultaneous liver kidney transplant (SLKT) and shortages of organs for transplantation. Although these well-compensated patients may not need a liver organ, the alternative of kidney transplant alone (KTA) poses the risk of liver decompensation. Therefore, we aim to characterize outcomes among patients with compensated cirrhosis and chronic kidney disease listed for SLKT or receiving KTA to inform clinical decisions. Methods: The 2-part retrospective study included a national cohort of patients listed for SLKT in United Network for Organ Sharing from January 2003 to June 2019 with Child A cirrhosis, with model for end-stage liver disease <25, and receiving dialysis; and a cohort of patients who underwent KTA from 2004 to 2019 with Child A cirrhosis identified through a 4-center chart review. Waitlist outcomes (SLKT, death, and clinical improvement) and post-KTA liver decompensation and survival were evaluated in the cohorts, respectively. Results: In the national SLKT cohort (N = 705, median age 56 y, 68.8% male), 5-y cumulative incidence of SLKT was 43.1%, death 32.1%, and clinical improvement 9.1%. Among SLKT recipients, 36.3% remained Child A without ascites or encephalopathy at transplant. In the local KTA cohort (N = 34, median age 54 y, 79.4% male), none had ascites or hepatic encephalopathy before KTA, but 15 had clinical portal hypertension. Five-y post-KTA incidence of liver decompensation was 36.8%, and survival was 89.2%. Conclusions: SLKT may not be necessary for some patients with compensated cirrhosis needing kidney transplant. KTA is safe for selected patients with intact liver biochemical function, even with portal hypertension but without hepatic encephalopathy or ascites. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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