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Title: Combined Liver-Kidney Transplantation.
Agency: Agency for Health Care Policy and Research/Center for Health Care Technology
(formerly the Office of Health Technology Assessment).
Contact: Martin Erlichman, M.S., Senior Health Science Analyst; Thomas V. Holohan, M.D.,
Status: Technology Review: Published, 1995.
Primary Objective: Scientific evaluation regarding the clinical effectiveness and appropriateness
Methods Used: Synthesis of published literature and information solicited from Public Health
Service agencies and the national Scientific Registry for Organ Transplantation.
Data Identification: English language journal articles, textbooks and Registry data published
between 1984 and 1994 available through the search capabilities of the National Library of
Medicine and the United Network for Organ Sharing (UNOS) database. Key words:
"Transplantation," "Combined Liver-Kidney Transplantation," "Simultaneous Liver-Kidney
Study Selection: Five studies and Registry data providing patient and graft survival.
Data Extraction: Outcome data of patient survival, graft survival, duration of followup, and
transplant history, comparing results of CLKT with isolated liver and isolated kidney procedures.
Key Results/Findings: Patient survival for CLKT in 5 studies with 4 to 38 patients ranged from
68% to 100% for periods of time ranging from 6 weeks to 7 years. Patient survival of 217
Registry patients was 74% with no prior transplant and 50% with a prior liver transplant. 1-year
patient survival in the UNOS Registry for isolated liver transplant was 75% with no prior
transplant and 51% with a prior transplant.
Conclusions/Options/Recommendations: CLKT performed as the initial transplant procedure
appears to provide patients with both kidney and liver failure a 1-year survival probability
equivalent to that following isolated liver transplantation in patients with liver failure alone. CLKT
following prior liver transplant appears to be associated with a significant decrement in survival.