జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

The First Case Series of Combined Liver-Kidney Transplantation (CLKT) from Thailand

Abhasnee Sobhonslidsuk, Surasak Leelaudomlipi, Pongphob Intaraprasong, Sasinee Tongprasert, Piyaporn Kaewdoung, Supanna Petraksa, Piyanut Pootracool, Somchai Viengteerawat, Pattana Sornmayura, Napat Angkathunyakul, Suthus Sriphojanart, Vasant Sumethkul

From the hospital database, four patients underwent CLKT. Three patients had ESRD and cirrhosis. Causes of cirrhosis were chronic hepatitis B and chronic hepatitis C in two and one patient. The fourth patient underwent CLKT due to subfulminant liver failure and prolonged acute renal failure with severely damaged kidney and required hemodialysis for 5 weeks. The waiting time ranged from 6 to 1988 days. After CLKT, one patient required hemodialysis for 45 days because of prolonged acute tubular necrosis. Mild early liver graft dysfunction occurred in one patient. Induction regimens were IL2-receptor blockers, steroids and tacrolimus in three patients, and steroids combining with tacrolimus in one patient. Maintenance regimens included tacrolimus, mycophenolate mofetil (with or without low-dose prednisolone). One-year graft and patient survival rate was 100%. Median follow-up time was 2.2 years. None developed liver or renal graft rejection. At 6 and 12 months, median creatinine levels were 1.30 and 1.13 mg/dl. At the last visits, median creatinine level was 1.05 mg/dl with median eGFR of 76.45 ml/min. CLKT may be done in the patients with ESRD and viral hepatitis-related cirrhosis even without portal hypertension. Other indication is for patients with acute liver failure with severely damaged ARF.