Combined liver-kidney transplantation: long-term follow up in 18 patients

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Abstract
Since August 1992, 18 patients underwent combined liver and kidney transplantation. Eight patients had lymphocytotoxic antibodies pretransplant and 5 of these patients (27.7%) had a positive crossmatch. Fifteen patients received cyclosporine‐based immunosuppression and 3 patients were treated with a tacrolimus‐based immunosuppressive protocol. One patient died in the postoperative course due to intractable bleeding episodes after 96 days and one kidney graft was lost due to technical complications. The 1‐year survival rate of patients with combined transplantation was 95% vs 87% in patients with liver transplantation alone. None of the patients with a positive crossmatch experienced a hyperacute rejection of the kidney. The long‐term patient and graft survival was not impaired in patients with a positive crossmatch. These results suggest that combined liver‐kidney transplantation is a safe treatment for enD‐stage liver and renal disease. A positive crossmatch or positive lymphocytotoxic antibodies are not contraindications for a combined transplantation.