Combined liver and kidney transplantation:A report of 15 cases

Objective To study the time,indications and use of immunosuppressant for combined liver and kidney transplantation（CLKT）. Methods Indications,time and immunosuppressant dose for CLKT in 15 patients admitted to our hospital were analyzed and their liver and kidney functions were summarized. Results All the patients were survived and followed up for 1.5-8 years（mean 3.6±1.2 years）.Renal failure occurred in 1 patient after CLKT and recovered 2 weeks after renal replacement therapy（RRT）.Renogram showed that the original kidney function recovered 2 months after CLKT in 1 patient who received RRT for 4 weeks before operation.The patients were treated with combined immunosuppressants（tacrolimus,mycophenolate and hormone）.The time to use hormone and mycophenolate in patients after CLKT was similar to that in those after liver transplantation.The dose of tacrolimus used in patients early and 6 months after CLKT was similar to that in those after liver transplantation,but significantly lower than that in those after renal transplantation（P＜0.05）.No significant difference was observed in rejection after liver or renal transplantation. Conclusion CLKT should be performed for patients with hepatic and renal syndrome（HRS） who received RRT for more than 6 weeks before operation and for those with liver failure accompanying primary renal disease with their proteinuria ＞500mg/d,GFR＜30ml/min or glomerulosclerose ＞30% detected by biopsy.Immunosuppressant can achieve satisfactory outcomes in patients after CLKT.Mycophenolate and hormone should be withdrawn after 6 months.The dose of tacrolimus is smaller for patients after CLKT than for those after renal transplantation.