Combined liver-kidney transplant (CLKT): Procedure and Complications

Combined liver-kidney transplant (CLKT): Procedure and Complications involved

Combined liver-kidney transplant

Combined Liver-Kidney Transplantation (CLKT) is an effective procedure to remove both the liver & kidney in patients with severe multiple organ failures. It is a very rare type of transplantation. 

In this blog, we have covered everything you would need to know about the Combined liver-kidney transplant procedure. 

CLKT: Who needs it? 

As the name implies, CLKT involves removing or replacing both the liver and kidney from the body. 

Patients who experience multiple organ failures or severe, irreversible hepatic diseases typically prefer this procedure.

In metabolic diseases where the defect lies in the liver and the organ affected is the kidney, it is logical to transplant both simultaneously. 

It turns out to be a life-saving procedure for patients with a genetic defect in the liver in the presence of advanced or end-stage chronic kidney disease.  

CLKT: Procedure 

Combined liver-kidney transplantation (CLKT) is a rarely performed difficult surgical procedure that entails the simultaneous transplanting of a kidney and all or a part of the liver from the same donor. 

The technical aspects of both isolated Liver Transplant (LT) and Kidney Transplant (KT) are incorporated
 during combined liver-kidney transplantation. 

Depending on the size match between the donor and the recipient, the recipient’s liver can be replaced after hepatectomy by a full size, a reduced size, or a split liver graft (donor liver split between two recipients). 

The organs are often from a deceased adult donor, although live donor CLKT has also been done with a left-lateral liver graft and kidney from the same donor (a parent). 

The weight of the split or reduced-size liver must surpass 2% of the recipient’s body weight in order to guarantee there is enough functioning

As in isolated KT, a single kidney is implanted extraperitoneally into the right or left iliac fossa following
 the liver implantation. 

The kidney can also be inserted into the abdominal cavity if there isn’t enough room.

In Autosomal recessive polycystic kidney disease (ARPKD) patients before CLKT, unilateral or bilateral nephrectomy is frequently done to make enough room for the organs. When using relatively young donors’ organs, it is possible to transplant both kidneys into the same patient at once.

Complications involved in CLKT: 

CLKT is a challenging major surgical procedure, and early post-operative problems are frequently reported
 as significant organ removal from the body, leading to some serious complications. Some of the complications that could be followed after a CLKT procedure include:

  • Active & frequent infections
  • Present or recent malignancy
  • Severe, irreversible pulmonary or heart diseases
  • Severe non-adherence 
  • Patients with liver cirrhosis may experience Porto pulmonary hypertension

Long-term chronic kidney disease may increase your chances of cardiovascular illnesses, thus timely diagnosis of CLKT is extremely crucial. Additionally, chronic liver illness and long-term chronic renal
disease are linked to increased weakness and a higher likelihood of a failed transplant. 

However, compared to unilateral liver transplantation or sequential liver and kidney transplantation, liver survival rates in CLKT are the same. Given the difficulty of the surgery, acute complications are not rare.

However, these can be minimized by taking the best safeguards and managing issues as they arise.

Children who have received CLKT have positive long-term outcomes, including high overall long-term survival rates when the procedure is carried out at certified centres with knowledge and experience.

Disclaimer : This website does not provide medical advice.

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