A Report of 3 Cases and Literature Review of Combined Liver and Kidney Transplanta-tion after Renal Transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MINGYing-zi , LIUHong , ZHUANGQuan , SHEXing-guo , NIUYing , SHAOMing-jie , ZHANGPeng-peng , ZENGQi-hong , ZHOUWei , YANGMin ,  YEQi-fa

Organ Transplantation Center, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China;

Corresponding author：

YEQi-fa, Email: yqf_china@163.com

Keywords：

Combined liver and kidney transplantation; Hepatorenal syndrome; Renal transplantation

DOI：

10.7507/1007-9424.20150273

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the decision of combined liver and kidney transplantation (CLKT) after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT. Methods The data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures. Results Three patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, and one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT. Conclusions The surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients' long-term survival.

Citation： MINGYing-zi, LIUHong, ZHUANGQuan, SHEXing-guo, NIUYing, SHAOMing-jie, ZHANGPeng-peng, ZENGQi-hong, ZHOUWei, YANGMin, YEQi-fa. A Report of 3 Cases and Literature Review of Combined Liver and Kidney Transplanta-tion after Renal Transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(9): 1036-1041. doi: 10.7507/1007-9424.20150273 Copy

1.	Ming Y, Shao M, Tian T, et al. Outcome of kidney transplantation between controlled cardiac death and brain death donors:a meta-analysis. Chin Med J (Engl), 2014, 127(15):2829-2836.
2.	Puttarajappa C, Yabes J, Bei L, et al. Cancer risk with alemtuzumab following kidney transplantation. Clin Transplant, 2013, 27(3):E264-E271.
3.	Tanriover B, Mejia A, Weinstein J, et al. Analysis of kidney function and biopsy results in liver failure patients with renal dysfunction:a new look to combined liver kidney allocation in the post-MELD era. Transplantation, 2008, 86(11):1548-1553.
4.	Bahirwani R, Reddy KR. Outcomes after liver transplantation:chronic kidney disease. Liver Transpl, 2009, 15 (Suppl 2):S70-S74.
5.	Aggarwal HK, Jain D, Singla S, et al. Assessment of renal functions in patients of chronic liver disease. Ren Fail, 2015, 4:1-7.
6.	Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med, 2009, 361(13):1279-1290.
7.	Gonwa TA, Mai ML, Melton LB, et al. End-stage renal disease (ESRD) after orthotopic liver transplantation (OLTX) using calcineurin-based immunotherapy:risk of development and treatment. Transplantation, 2001, 72(12):1934-1939.
8.	Locke JE, Warren DS, Singer AL, et al. Declining outcomes in simul-taneous liver-kidney transplantation in the MELD era:ineffective usage of renal allografts. Transplantation, 2008, 85(7):935-942.
9.	O,Leary JG, Orloff SL, Levitsky J, et al. Keeping high MELD liver transplant candidates alive. Liver Transpl, 2015 Sep 3.[Epub ahead of print].
10.	Antunes M, Teixeira A, Fortuna P, et al. Infections after liver trans-plantation:a retrospective, single-center study. Transplant Proc, 2015, 7(4):1019-1024.
11.	Paramesh AS, Roayaie S, Doan Y, et al. Postliver transplant acute renal failure:factors predicting development of end-stage renal disease. Clin Transplant, 2004, 18(1):94-99.
12.	Bémeur C, Butterworth RF. Nutrition in the management of cirrhosis and its neurological complications. J Clin Exp Hepatol, 2014, 4(2):141-150.
13.	Neau-Cransac M, Le Bail B, Guidicelli G, et al. Evolution of serum and intra-graft donor-specific anti-HLA antibodies in a patient with two consecutive livertransplantations. Transpl Immunol, 2015 Aug 28.[Epub ahead of print].
14.	Simpson N, Cho YW, Cicciarelli JC, et al. Comparison of renal allograft outcomes in combined liver-kidney transplantation versus subsequent kidney transplantation in liver transplant recipients:analysis of UNOS database. Transplantation, 2006, 82(10):1298-1303.
15.	Schmitt TM, Kumer SC, Al-Osaimi A, et al. Combined liver-kidney and liver transplantation in patients with renal failure outcomes in the MELD era. Transpl Int, 2009, 22(9):876-883.
16.	Chava SP, Singh B, Zaman MB, et al. Current indications for combined liver and kidney transplantation in adults. Transplant Rev (Orlando), 2009, 23(2):111-119.
17.	Narula N, Bourne M Jr, Bhagra A. Immunosuppression and a serious opportunistic infection:an unfortunate price to pay. BMJ Case Rep, 2015 Jul 7.[Epub ahead of print].
18.	Furman D, Davis MM. New approaches to understanding the immune response to vaccination and infection. Vaccine, 2015 Jul 29.[Epub ahead of print].
19.	Krishnamoorthy TL, Miezynska-Kurtycz J, Hodson J, et al. Long-term corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease. Liver Transpl, 2015 Sep 3.[Epub ahead of print].
20.	Van Wagner LB, Baker T, Ahya SN, et al. Outcomes of patients with hepatitis C undergoing simultaneous liver-kidney transplantation. J Hepatol, 2009, 51(5):874-880.
21.	Ming YZ, Hu J, Luo QZ, et al. Acute antibody-mediated rejection in presence of MICA-DSA and successful renal re-transplant with negative-MICA virtual crossmatch. PloS One, 2015, 10(5):1-10.
22.	Barth RN, Campos L, Kukuruga DL, et al. Antibody-mediated rejection of renal allograft in combined liver-kidney transplant. Clin Transplant, 2010, 24(5):685-690.
23.	Bray RA, Tarsitani C, Gebel HM, et al. Clinical cytometry and progress in HLA antibody detection. Methods Cell Biol, 2011, 103:285-310.
24.	Wu WK, Famure O, Li Y, et al. Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int, 2015 Jun 24.[Epub ahead of print].
25.	Brieva J, Coleman N, Lacey J, et al. Prediction of death in less than 60 minutes after withdrawal of cardiorespiratory support in potential organ donors after circulatory death. Transplantation, 2014, 98(10):1112-1118.
26.	Morrissey PE, Monaco AP. Donation after circulatory death:current practices, ongoing challenges, and potential improvements. Transplantation, 2014, 97(3):258-264.
27.	Kim JY, Akalin E, Dikman S, et al. The variable pathology of kidney disease after liver transplantation. Transplantation, 2010, 89(2):215-221.
28.	Davis CL, Feng S, Sung R, et al. Simultaneous liver-kidney transplan-tation:evaluation to decision making. Am J Transplant, 2007, 7(7):1702-1709.

1. Ming Y, Shao M, Tian T, et al. Outcome of kidney transplantation between controlled cardiac death and brain death donors:a meta-analysis. Chin Med J (Engl), 2014, 127(15):2829-2836.
2. Puttarajappa C, Yabes J, Bei L, et al. Cancer risk with alemtuzumab following kidney transplantation. Clin Transplant, 2013, 27(3):E264-E271.
3. Tanriover B, Mejia A, Weinstein J, et al. Analysis of kidney function and biopsy results in liver failure patients with renal dysfunction:a new look to combined liver kidney allocation in the post-MELD era. Transplantation, 2008, 86(11):1548-1553.
4. Bahirwani R, Reddy KR. Outcomes after liver transplantation:chronic kidney disease. Liver Transpl, 2009, 15 (Suppl 2):S70-S74.
5. Aggarwal HK, Jain D, Singla S, et al. Assessment of renal functions in patients of chronic liver disease. Ren Fail, 2015, 4:1-7.
6. Ginès P, Schrier RW. Renal failure in cirrhosis. N Engl J Med, 2009, 361(13):1279-1290.
7. Gonwa TA, Mai ML, Melton LB, et al. End-stage renal disease (ESRD) after orthotopic liver transplantation (OLTX) using calcineurin-based immunotherapy:risk of development and treatment. Transplantation, 2001, 72(12):1934-1939.
8. Locke JE, Warren DS, Singer AL, et al. Declining outcomes in simul-taneous liver-kidney transplantation in the MELD era:ineffective usage of renal allografts. Transplantation, 2008, 85(7):935-942.
9. O,Leary JG, Orloff SL, Levitsky J, et al. Keeping high MELD liver transplant candidates alive. Liver Transpl, 2015 Sep 3.[Epub ahead of print].
10. Antunes M, Teixeira A, Fortuna P, et al. Infections after liver trans-plantation:a retrospective, single-center study. Transplant Proc, 2015, 7(4):1019-1024.
11. Paramesh AS, Roayaie S, Doan Y, et al. Postliver transplant acute renal failure:factors predicting development of end-stage renal disease. Clin Transplant, 2004, 18(1):94-99.
12. Bémeur C, Butterworth RF. Nutrition in the management of cirrhosis and its neurological complications. J Clin Exp Hepatol, 2014, 4(2):141-150.
13. Neau-Cransac M, Le Bail B, Guidicelli G, et al. Evolution of serum and intra-graft donor-specific anti-HLA antibodies in a patient with two consecutive livertransplantations. Transpl Immunol, 2015 Aug 28.[Epub ahead of print].
14. Simpson N, Cho YW, Cicciarelli JC, et al. Comparison of renal allograft outcomes in combined liver-kidney transplantation versus subsequent kidney transplantation in liver transplant recipients:analysis of UNOS database. Transplantation, 2006, 82(10):1298-1303.
15. Schmitt TM, Kumer SC, Al-Osaimi A, et al. Combined liver-kidney and liver transplantation in patients with renal failure outcomes in the MELD era. Transpl Int, 2009, 22(9):876-883.
16. Chava SP, Singh B, Zaman MB, et al. Current indications for combined liver and kidney transplantation in adults. Transplant Rev (Orlando), 2009, 23(2):111-119.
17. Narula N, Bourne M Jr, Bhagra A. Immunosuppression and a serious opportunistic infection:an unfortunate price to pay. BMJ Case Rep, 2015 Jul 7.[Epub ahead of print].
18. Furman D, Davis MM. New approaches to understanding the immune response to vaccination and infection. Vaccine, 2015 Jul 29.[Epub ahead of print].
19. Krishnamoorthy TL, Miezynska-Kurtycz J, Hodson J, et al. Long-term corticosteroid use after liver transplantation for autoimmune hepatitis is safe and associated with a lower incidence of recurrent disease. Liver Transpl, 2015 Sep 3.[Epub ahead of print].
20. Van Wagner LB, Baker T, Ahya SN, et al. Outcomes of patients with hepatitis C undergoing simultaneous liver-kidney transplantation. J Hepatol, 2009, 51(5):874-880.
21. Ming YZ, Hu J, Luo QZ, et al. Acute antibody-mediated rejection in presence of MICA-DSA and successful renal re-transplant with negative-MICA virtual crossmatch. PloS One, 2015, 10(5):1-10.
22. Barth RN, Campos L, Kukuruga DL, et al. Antibody-mediated rejection of renal allograft in combined liver-kidney transplant. Clin Transplant, 2010, 24(5):685-690.
23. Bray RA, Tarsitani C, Gebel HM, et al. Clinical cytometry and progress in HLA antibody detection. Methods Cell Biol, 2011, 103:285-310.
24. Wu WK, Famure O, Li Y, et al. Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int, 2015 Jun 24.[Epub ahead of print].
25. Brieva J, Coleman N, Lacey J, et al. Prediction of death in less than 60 minutes after withdrawal of cardiorespiratory support in potential organ donors after circulatory death. Transplantation, 2014, 98(10):1112-1118.
26. Morrissey PE, Monaco AP. Donation after circulatory death:current practices, ongoing challenges, and potential improvements. Transplantation, 2014, 97(3):258-264.
27. Kim JY, Akalin E, Dikman S, et al. The variable pathology of kidney disease after liver transplantation. Transplantation, 2010, 89(2):215-221.
28. Davis CL, Feng S, Sung R, et al. Simultaneous liver-kidney transplan-tation:evaluation to decision making. Am J Transplant, 2007, 7(7):1702-1709.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A Report of 3 Cases and Literature Review of Combined Liver and Kidney Transplanta-tion after Renal Transplantation

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