Simultaneous liver kidney transplant

A significant number of patients awaiting liver transplantation have associated renal failure. Simultaneous Liver and Kidney (SLK) transplantation is increasingly offered especially since the introduction of Model for End-Stage Liver Disease (MELD). The appropriate selection of candidates for SLK is more complex and less well defined than for liver transplant alone (LTA) due to our inability to predict accurately the extent of reversibility of acute or functional renal injury, particularly in patients who also have some background renal impairment. The current allocation policy is flexible, providing a kidney to any liver transplant candidate based solely on local physician opinion. This latitude has resulted in tremendous diversity of opinion and practice. More studies are required to delineate the predictors of renal recovery, the factors which influence renal recovery and to understand the complex interplay between the background renal impairment, the functional effects on kidney of advanced liver disease, and the effect of nephrotoxic drugs including CNIs. The long-term results of SLK are comparable to those of isolated LT. The liver protects the kidney from disease recurrence and allograft loss in metabolic diseases and its immunoprotective effect has enabled renal transplant in highly sensitised patients with positive cross-match and previously failed renal transplants.