Phuong-Thu Pham
Ronald Reagan UCLA Medical Center, USA
Title: Clinical decision-making dilemma: Liver alone or combined liver-kidney transplantation?
Biography
Biography: Phuong-Thu Pham
Abstract
With the introduction of the MELD score for the allocation of orthotopic liver transplant (OLT) in February 2002, arnstriking 278% increase in the number of simultaneous liver-kidney transplants (SLKT) was observed during the 9-yearrnperiod post-MELD when compared with the preceding 9-year in the pre-MELD era (pre- vs. post-MELD era, n=1049 vs. 2914rnrespectively). For OLT candidates with simultaneous end-stage kidney failure, SLKT is a well-established effective therapeuticrnoption for virtually all suitable candidates. However, there have been no well-defined guidelines to determine whether a kidney rntransplant should be offered to OLT candidates who have chronic kidney disease (CKD) or prolonged acute kidney injuryrn(AKI) secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) while awaiting a liver transplant. Specificrnchallenges in the decision making process include the accurate assessment of the degree of existing renal dysfunction in thosernwith CKD, progression of established CKD and the prediction of the extent of renal function recovery in those with AKI withrnor without underlying CKD. Currently existing consensus guidelines for SLKT in OLT wait-listed candidates are presentedrnfollowed by the author’s opinion on identification of candidates who are best suited for double-organ transplantation.