Four Cases of Combined Liver-Kidney Transplantation.

Combined liver-kidney transplantation (LKT) has been increasingly performed procedure for end-stage liver and kidney disease. We experienced four cases of LKT. All patients were affected by viral hepatopathy. There were three patients of hepatocellular carcinoma, treated with trans-arterial chemoembolization or chemotherapy and one cirrhotic patient. The causes of chronic renal failure were polycystic kidney disease in one patient, glomerulonephropathies in two, and diabetes mellitus in one. Three of them were on dialysis treatment. All patients were selected based on blood group identity and negative cross-match before LKT. There was no post-operative surgical complication or acute rejection. At the mean follow-up of 37 months after LKT, all patients showed normal hepatic and renal function except for one case of biopsy-proven tacrolimus nephrotoxicity. Seroconversions of HBsAg, HBeAg, and HBV-DNA were achieved in hepatitis B positive patients. However, HCV-RNA was sustained in hepatitis C positive patient after LKT. Alpha-fetoprotein was normalized in every HCC patient. Combined liver-kidney transplantation can be a proper therapeutic procedure for the patient with liver failure and irreversible renal disease, and it can be done safely and effectively.