Outcome of Kidney Alone Transplantation in Patients with End Stage Kidney Disease with Compensated Cirrhosis.

Background: There is a lack of data regarding the need for liver transplantation in end-stage kidney disease (ESKD) patients with compensated cirrhosis. Overall outcomes of isolated kidney transplants in these patients in terms of renal graft outcome, hepatic decompensation, and survival are less clear.

Materials and methods: This is the retrospective analysis of patients treated at a single center. Patients with cirrhosis with evidence of portal hypertension who underwent kidney transplantation were compared with a matched control group without chronic liver disease (CLD) who underwent kidney transplantation during the same period.

Results: Nineteen CLD patients with evidence of portal hypertension confirmed by endoscopy showing varices (8/19), hepatic venous pressure gradient (HVPG) >5 (12/19), or portosystemic collaterals on imaging (8/19) underwent kidney transplantation and were compared with 38 patients without liver disease transplanted during the same period. The discharge of creatinine was similar in both groups. The median follow-up was approximately 4 years in both groups, with the last mean serum creatinine of 1.3 and 1.37 mg/dl (unit for creatinine) in the patient and control groups (P = 0.382). Biopsy-proven acute rejections were similar [3 (15.8%) vs. 7 (18.4%), p = 1]. Two patients died in the CLD group, one due to hepatic decompensation with sepsis and the other due to cardiac cause. Four patients died in the control group (3 with sepsis and 1 with cardiac cause). Two patients had liver decompensation post-transplant (1-month post-transplant with ascites, 4 years post-transplant with ascites and hepatic encephalopathy).

Conclusion: Kidney-alone transplantation in a carefully selected population with CLD and portal hypertension has comparable outcomes to those without liver disease.