Introduction
Due to significant impairment to either the liver or kidney, medical professionals advise the consideration of a transplant procedure for the affected organ. However, in cases when there is irreversible damage to both organs, it is possible for a medical practitioner or healthcare expert to suggest the option of a combination liver and kidney transplant (CLKT).
What Is Combined Liver and Kidney Transplantation?
A combined liver and kidney transplant (CLKT) is recommended for end-stage liver and renal disease. CLKT may potentially assist patients with polycystic liver or kidney disease, hyperoxaluria(a metabolic disease characterized by excessive acid excretion in the urine), cirrhosis (characterized by the progressive destruction and scarring of the liver), acute renal failure, or hepatorenal syndrome is a multiorgan disorder involving the liver and kidneys, undergoing hemodialysis for more than two months.
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When kidney disease is temporary, liver and kidney transplantation are harder. Hepatorenal syndrome is liver disease-induced renal insufficiency that may be reversed. A liver transplant alone is the preferred treatment for hepatorenal syndrome.
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Renal failure negatively impacts liver transplant alone (LTA) patients; hence, liver and kidney transplants are recommended for cirrhosis patients with renal failure.
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The renal failure in chronic liver disease patients causes substantial mortality and morbidity following liver transplant alone.
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However, identifying a renal dysfunction that defines the benefit of a liver and kidney transplant instead of a liver transplant alone is difficult.
When Is a Transplant of Both the Liver and Kidneys Necessary?
A combined liver and kidney transplant (CLKT) may be considered appropriate in cases where:
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The individual is undergoing simultaneous liver and renal failure.
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The individual presents with end-stage renal disease, which is attributed to gene mutations that have resulted in liver dysfunction. Additionally, there is evidence of end-stage liver disease accompanied by kidney impairment.
CLKT has the capacity to attend to associated uncommon ailments, including but not limited to the following examples:
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Alpha-1 antitrypsin insufficiency is a hereditary condition characterized by the accumulation of atypical proteins within the liver, resulting in hepatic impairment.
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Atypical hemolytic uremic syndrome (aHUS) is an infrequent pathological condition distinguished by thrombocytopenia (characterized by a low platelet count), hemolysis (medical term for the elimination of red blood cells.), and severe renal insufficiency.
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Acute intermittent porphyria (AIP) is a medical condition characterized by abnormalities in enzymes that play a crucial role in the synthesis of hemoglobin inside the liver or bone marrow.
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Glycogen storage disorder is a medical condition that impairs the body's capacity to metabolize glycogen, potentially resulting in hypoglycemia and hepatic injury.
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The concept of hereditary complement refers to the transmission of genetic traits from one generation to the next. C3 deficiency is an uncommon immunodeficiency characterized by reduced levels of C3 plasma, which can result in recurrent bacterial infections.
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The term "homozygous protein" refers to a protein that is produced from two identical alleles of a specific gene; C deficiency is a relatively uncommon condition characterized by reduced amounts of protein C, resulting in the potential for aberrant blood clot formation.
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Acyltransferase deficiency is characterized by aberrant concentrations of unbound cholesterol, leading to the accumulation of surplus cholesterol in various tissues across the body.
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Methylmalonic aciduria refers to a collection of hereditary, occurring rarely, conditions that can result in the buildup of methylmalonic acid, a compound typically eliminated by the body following protein consumption.
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Nephronophthisis is a renal disorder that has the potential to inflict harm upon the liver as well.
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Primary hyperoxaluria is an uncommon medical disorder characterized by the abnormal accumulation of oxalate in the kidneys and other organs. This condition is frequently identified as a common etiological factor.
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In cases where an individual is afflicted with end-stage kidney disease and possesses genetic abnormalities affecting the liver, it is plausible to consider a liver transplant as a potential substitute for gene therapy.
Individuals with specific medical disorders that may heighten the likelihood of organ rejection may not meet the criteria for candidature in a Combined Liver and Kidney Transplantation (CLKT) procedure. These illnesses may encompass substance use disorder, cancer, and other medical conditions that have the potential to affect the immune system. Additionally, lung or heart diseases are also included in this category.
What Is the Procedure for Performing a Liver and Kidney Transplant Simultaneously?
A CLKT is conducted within a healthcare facility.
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Prior to the commencement of the surgery, it is imperative to undergo blood work in order to ascertain the compatibility between the recipient and the donor organs. Additionally, the patient will be administered general anesthesia.
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A kidney transplantation procedure entails the surgical implantation of a donated kidney into the recipient's lower abdominal region, often lasting for a duration of three to four hours. The placement of the new kidney occurs in a subrenal position relative to the preexisting kidneys. In cases when the preexisting kidneys are shown to be malignant or pose an elevated risk of hypertension, their removal may be warranted.
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A liver transplantation procedure is conducted as an independent surgical intervention, requiring a minimum duration of 12 hours for its completion. In contrast to kidney transplantation, wherein the recipient's native kidneys may be retained, liver transplantation invariably necessitates the excision of the recipient's native liver.
What Is the Postoperative Healing Process Like for Patients Undergoing a Combination of Liver and Kidney Transplantation?
Following a cardiac left knee transplantation (CLKT), it is customary for patients to undergo a hospitalization period lasting around two weeks. Throughout this period, the healthcare staff will undertake diligent surveillance of conditions in order to ensure the optimal functioning of the transplanted organs.
In addition, it is necessary to administer drugs in order to mitigate the likelihood of organ rejection. Immunosuppressants are administered to inhibit the immune response of the recipient's body toward the transplanted kidney and liver, thereby mitigating the rejection of these organs as foreign entities.
If feasible, it is imperative to refrain from contact with individuals who are unwell. The administration of immunosuppressants can result in the attenuation of the immune system, hence reducing its ability to effectively combat infections.
What Are the Adverse Effects Associated With Immunosuppressant Medications?
In addition to an elevated incidence of infections, the administration of immunosuppressant drugs may also give rise to:
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The individual is experiencing gastrointestinal discomfort, elevated body temperature, dysuria (a condition characterized by discomfort or challenges during urination.), a lingering cough, and symptoms resembling those of a common cold.
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Adhering to the prescribed drug regimen is of utmost significance. It is imperative to consult with a healthcare professional before discontinuing the usage of immunosuppressants due to potential negative effects.
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It is advisable to consult a healthcare practitioner before initiating the use of any novel pharmaceuticals or supplements in order to mitigate the risk of potential interactions with one's existing treatment regimen.
In addition, a medical practitioner will advise to arrange further sessions for further evaluation and monitoring. These procedures will encompass physical examinations in addition to blood tests in order to ascertain the proper functioning of the liver and kidneys.
Conclusion
End-stage liver disease and chronic kidney disease on renal replacement therapy, as well as genetic illness, appear to benefit from combined liver-kidney transplantation. CLKT has received more cirrhotic renal failure patients since the MELD score was established as an organ allocation mechanism. Due to the scarcity of organ donors, determining which patients will benefit the most from this treatment is critical. Due to a scarcity of evidence on renal function recovery factors, deciding whether to undergo orthotopic transplantation alone or combined kidney-liver transplantation is problematic. In individuals with hepatorenal syndrome and acute renal failure, distinguishing between functional and irreversible impairment is difficult.
