Combined liver-kidney transplant is a routine procedure in many transplant centers. The increase in its number coincided with the introduction in 2002 of the MELD (Model for End-stage Liver Disease) score for allocation of livers, prioritizing patients with renal dysfunction.
: To analyze the experience with combined liver-kidney transplantation in a liver transplant center in Brazil.
: A retrospective review was conducted. All transplants were performed using grafts from deceased donors.
: Sixteen combined liver-kidney transplantations were performed in the same period, which corresponds to 2.7% and 2.5% of the kidney and liver transplants, respectively. Fourteen patients were male (87.5 %) and two were female (12.5%). The average patients and donors age was 57.3±9.1 and 32.7±13.1, respectively. The MELD score mean was 23.6±3.67. The main cause of liver dysfunction were chronic hepatitis C virus (n=9). As for renal dysfunction, diabetic nephropathy (n=4) was the most frequent. There were six deaths, two of them by severe dysfunction of the liver graft and four by infectious causes. The 1, 3 and 5 years survival rate in patients undergoing liver-kidney transplantations was 68.8%, 57.3% and 57.3%, respectively.
: The survival rates achieved in this series are considered satisfactory and show that this procedure has an acceptable morbidity and survival.
Multiorgan dysfunction involving the liver and kidneys is common in patients with end-stage heart failure. The first combined liver-kidney transplant (CLKT) was performed by Margreiter in 1983, and it is a routine procedure in many transplant centers representing 1-8% of liver transplant candidates5.
Hepatic and renal dysfunction may be secondary to a systemic disease process affecting the heart, liver, and kidneys or may be a consequence of heart failure with venous congestion and arterial hypoperfusion2,4.
Despite the complexity and costs involved, the results of this type of transplant are optimistic, as these are terminally ill patients.
Our objective was to report the first Latin American experience in triple transplantation in the same surgical time (heart, liver, and kidney), which took place at Hospital São Lucas Copacabana1.
The organ receiver was a 56-year-old male, physical education teacher, diagnosed with dilated cardiomyopathy with biventricular dysfunction of undetermined origin and compensated cirrhosis of probable cardiogenic etiology diagnosed in 2018 during a cholecystectomy. Chronic kidney disease was due to cardiorenal syndrome.
After follow-up of the case, triple liver-cardiac-renal transplantation was indicated.
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