Friday, November 19, 2010

ASN Live Update 2010:when do to combined liver-kidney transplants?

When to do a combined Liver and Kidney Transplant?
Take home points from Dr.Aklin's talk1.      After the introduction of MELD scoring system, the crt was in that and that led to increase number of combined liver and kidney transplants from 2% to 6%
2.      Who gets combined: ESRD with Cirrhosis, ESLD with GFR<30, ESLD +AKI+>8 weeks on HD, ESLD + biopsy proven >30% IFTA and >30% glomerulosclerosis
3.      After Introduction of MELD, the outcomes of Liver and kidney combined were worse , not donor related, perhaps recipient related as they were sicker. Now if MELD>23, they do worse and surgeons think twice before a combined liver kidney
4.      A biopsy proven way of deciding if you want to do a kidney and liver was suggested.  Interestingly they found that the most common biopsy finding was GN and DM being top, followed by MPGN, FSGS and IgA nephropathy
5.      >30% had biopsy complications, especially inr>1.5
6.      Interesting GN found after liver transplant alone( some sort of nodular GN, as it looks like DM nephropathy but they don’t have DM and never develop it)

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