Combined liver-kidney transplantation: analysis of patients with preformed lymphocytotoxic antibodies.

W ITH THE INCREASING complexity of patients undergoing transplantation, the transplant services are called on to evaluate a variety of patients with concomitant metabolic derangements. Optimal function of an allograft and management of these patients in the posttransplant period may require consideration of multiorgan transplantation. The concept of multiorgan transplantation has become a reality. Combined pancreas-kidney transplantation was the first example of this. Thereafter, combined heartkidney, heart-lungs, and heart-liver transplants have been reported. In each instance, the combined transplants have been performed in order to assure long-term allograft function by correcting coexisting dysfunction of other organ systems. A number of liver transplant candidates will have preexisting renal dysfunction, either secondary to renal flow abnormalities, drug toxicity, or secondary to an intrinsic renal defect. eg, interstitial nephritis, glomerulonephritis, polycystic renal disease.1,2 While correction of secondary renal dysfunction can be expected in the former group, the posttransplant management in the latter group is complicated by the necessity for adjustments in the immunosuppressive regimens.3 Thus, if chronic renal disease can be documented before hepatic transplantation, combined liver-kidney transplantation should be considered. In this report, we address combined