KIDNEY TRANSPLANTATION AFTER LIVER TRANSPLANTATION. A SINGLE CENTER EXPERIENCE.:

205 Introduction: Several factors are associated with renal failure after liver transplantation (OLT) and some patients require a kidney transplant after OLT. The purpose of this study is to determine if the results of kidney transplantation (KT) following OLT are comparable to the results of primary kidney transplants and if the KT has any impact on the functioning of the liver graft. Materials and Methods: Of the 1300 pts who underwent OLT at our institution from 1985 to 1997, 14 pts underwent KT after OLT. The data of these pts were analyzed regarding the diagnosis of renal failure, change in immunosuppression, hospital stay, incidence of complications, incidence of posttransplant acute tubular necrosis (ATN) and acute rejection (ACR), change in liver function and patient and graft survival. Kaplan-Meier survival estimates were used for the statistical analysis. Results: Fourteen pts, 8 male and 6 female, mean age 46.5 yrs (± 8.5 yrs), underwent 15 KT after OLT. Mean follow-up was 32 mos (± 37). Renal failure was caused by cyclosporine toxicity in 6 pts, non-resolving hepatorenal syndrome in 5, polycystic kidney disease in 2 and ATN in 1. One patient was retransplanted for chronic rejection of the KT. Median time from OLT to KT was 49 mos (3-114 mos). Of the 12 pts already on cyclosporine, 5 pts remained on the same dose after the KT, 5 had the dose increased and 2 decreased. Two pts already on Prograf had the dose decreased. Median hospital stay was 9 days (4-60 days). Four of the 14 pts (28.5%) had a complication after the KT; 1 pt had a lymphocele, 1 pt had a urine leak, 1 had progressive liver failure and 1 CMV esophagitis. Three pts (21.4%) had ATN post KT requiring temporary hemodialysis. Three pts had ACR and 2 of them ultimately lost the kidney graft to chronic rejection. Only 1 pt suffered worsening liver function after the KT. Six pts died, 3 because of sepsis, 2 because of cardiac pathology and 1 because of aspiration.TableConclusions: The results of our analysis show that KT following OLT can be performed with a reasonable complication rate and incidence of ACR and that the liver graft does not suffer from the KT procedure. Nevertheless, patient and graft survival appear to be worse compared with those undergoing primary KT. Further studies are needed in order to better understand this difference in survival and better define those patients who may benefit from a kidney transplant after their liver transplant.