Simultaneous Liver-Kidney Transplant Carries Benefits

Dual transplant may have a protective role against cellular rejection.

Patients who receive simultaneous liver-kidney transplantation may experience long-term benefits compared with patients who receive a kidney transplant alone.

Physicians from the Mayo Clinic examined kidney biopsies from 68 consecutive liver-kidney transplant recipients, 14 with donor specific alloantibodies, and 54 with low or no donor-specific alloantibodies.

The results were then compared to the biopsies of patients who received a kidney transplant alone, including a comparable breakdown of high and low donor specific alloantibodies.

Factors within the study included the overall 5-year patient and graft or transplant survival, acute rejection and chronic kidney damage, and overall measures of kidney function.

The results of a study published in Kidney International found that 5 years after the simultaneous liver-kidney transplant in patients with donor-specific alloantibodies, there was a 7.1% rate of acute rejection compared with 46.4% in patients who had a kidney transplant alone.

“We know that a healthy liver can reduce the levels of circulating donor-specific alloantibodies, which can lead to rejection of a transplanted organ in kidney transplant recipients,” said Timucin Taner, MD, PhD. “The findings from this study indicate that these positive benefits of a healthy liver in simultaneous liver-kidney transplants may be long-standing and that the liver may have a protective role against cellular rejection, as well.”

Additionally, there was no transplant-related kidney injury compared with 53.6% incidence of chronic injury for patients with the kidney transplant alone. The glomerular filtration rate was stable in simultaneous transplant patients, compared with a decline in GFR of 44% of patients with a kidney transplant alone.

“This study is promising, because it demonstrates the power of a well-functioning liver allograft in modulating host immune responses and positively influencing long-term outcomes of the kidney transplant in simultaneous liver-kidney transplant recipients,” Taner said. “More work is needed to better understand how far this benefit extends beyond transplantation, as well as how immunosuppressive therapies impact these outcomes.”