Combined liver and kidney transplantation

Haris Papafragkakis, Paul Martin, Enver Akalin

Research output: Contribution to journalArticle

26 Citations (Scopus)


PURPOSE OF REVIEW: Since the implementation of the model for end-stage liver disease scoring system for organ allocation in orthotopic liver transplantation in 2002, the number of combined liver and kidney transplantations (CLKTs) that have been performed in the USA has increased significantly. To standardize the evaluation and selection of CLKT candidates, consensus conferences were held in March 2006 and September 2007. In this article, we review the studies on CLKT, especially concentrating on studies published in 2008 and 2009, to assess the impact of the model for end-stage liver disease system and two consensus conferences. RECENT FINDINGS: The hepatorenal syndrome, usually a reversible cause of renal failure, has to be differentiated from other causes of chronic kidney disease that are potentially nonreversible and mandate CLKT. Despite published guidelines, it still remains difficult to clearly delineate appropriate candidates for CLKT, especially when the cause of renal disease remains controversial. Performing renal biopsies might help in decision-making. Chronic kidney disease patients with glomerular filtration rate less than 30 ml/min, hepatorenal syndrome patients with requirement of renal replacement therapy more than 8-12 weeks, and patients with renal biopsy findings of more than 30% fibrosis and glomerulosclerosis would get benefit receiving CLKT. SUMMARY: In this era of organ shortage, with tens of thousands of patients listed for kidney transplantation, it is paramount that the organs should be scrupulously allocated to those in real need. However, patients with advanced renal disease should not receive orthotopic liver transplantation alone, which significantly decreases their survival.

Original languageEnglish
Pages (from-to)263-268
Number of pages6
JournalCurrent Opinion in Organ Transplantation
Issue number3
StatePublished - Jun 1 2010


Liver Transplantation
Kidney Transplantation
Hepatorenal Syndrome
End Stage Liver Disease
Chronic Renal Insufficiency
Renal Replacement Therapy
Glomerular Filtration Rate
Renal Insufficiency
Decision Making


  • Hepatorenal syndrome
  • Kidney failure
  • Kidney transplantation
  • Liver transplantation
  • Model for end-stage liver disease

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

Cite this

Combined liver and kidney transplantation. / Papafragkakis, Haris; Martin, Paul; Akalin, Enver.

In: Current Opinion in Organ Transplantation, Vol. 15, No. 3, 01.06.2010, p. 263-268.

Research output: Contribution to journalArticle

Papafragkakis, Haris ; Martin, Paul ; Akalin, Enver. / Combined liver and kidney transplantation. In: Current Opinion in Organ Transplantation. 2010 ; Vol. 15, No. 3. pp. 263-268.
title = "Combined liver and kidney transplantation",
abstract = "Lippincott Williams & Wilkins.",
keywords = "Hepatorenal syndrome, Kidney failure, Kidney transplantation, Liver transplantation, Model for end-stage liver disease",
author = "Haris Papafragkakis and Paul Martin and Enver Akalin",
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journal = "Current Opinion in Organ Transplantation",
issn = "1087-2418",
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N2 - Lippincott Williams & Wilkins.

AB - Lippincott Williams & Wilkins.

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KW - Model for end-stage liver disease

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