Disparity in utilization of combined kidney-liver transplantation in the United States

Background: Orthotopic liver transplantation (OLT) is performed as a definitive treatment of acute and chronic liver failure. The prevalence of acute and chronic kidney diseases is substantially higher in this population secondary to diverse etiologies. Combined kidney-liver transplantation (CKLT) is widely performed in some centers, even though there are no definitive studies which support or contradict this practice. Methods: We comprehensively reviewed OLT as well as CKLT data from US transplant centers provided by United Network of Organ Sharing (UNOS). Results: The incidence of CKLT as a percentage of total OLTs performed has been increasing, especially in the post-MELD era (2002 and after). Moreover, there is a great disparity among centers in regard to percentage of CKLTs to total OLTs. Conclusion: We conclude that there is much difference of opinion among US transplant centers as to indications for CKLT. A more scientific approach to this problem including studies to assess the role of kidney biopsy in determining renal outcome after OLT is needed.