Clinical decision-making dilemma: Liver alone or combined liver-kidney transplantation?

4^th International Conference on Nephrology & Therapeutics

September 14-16, 2015 Baltimore, USA

Phuong-Thu Pham

Ronald Reagan UCLA Medical Center, USA

Keynote: J Nephrol Ther

Abstract :

With the introduction of the MELD score for the allocation of orthotopic liver transplant (OLT) in February 2002, a striking 278% increase in the number of simultaneous liver-kidney transplants (SLKT) was observed during the 9-year period post-MELD when compared with the preceding 9-year in the pre-MELD era (pre- vs. post-MELD era, n=1049 vs. 2914 respectively). For OLT candidates with simultaneous end-stage kidney failure, SLKT is a well-established effective therapeutic option for virtually all suitable candidates. However, there have been no well-defined guidelines to determine whether a kidney transplant should be offered to OLT candidates who have chronic kidney disease (CKD) or prolonged acute kidney injury (AKI) secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) while awaiting a liver transplant. Specific challenges in the decision making process include the accurate assessment of the degree of existing renal dysfunction in those with CKD, progression of established CKD and the prediction of the extent of renal function recovery in those with AKI with or without underlying CKD. Currently existing consensus guidelines for SLKT in OLT wait-listed candidates are presented followed by the author�s opinion on identification of candidates who are best suited for double-organ transplantation.

Biography :

Phuong-Thu Pham is a Professor of Medicine and Director of Outpatient Services of the Kidney Transplant Program at UCLA Medical Center. Her major areas of interest include recurrence of glomerular diseases following primary renal transplantation, new onset diabetes after transplantation, BK virus screening and management after kidney transplantation, the link between hypomagnesemia and renal function decline in patients with diabetes mellitus type 2 as well as in recipients of kidney transplant and acute and chronic kidney injury following liver transplantation. Her interests have resulted in publications in well-known Nephrology textbooks and journals as well as invitations to speak at both national and international meetings. She has written over 20 book chapters for major Nephrology and solid organ transplantation textbooks including Comprehensive Clinical Nephrology, Textbook of Organ Transplantation, Transplantation of the Liver, Pancreas, islet and stem cell transplantation for diabetes, Chronic Kidney Disease: Dialysis and Transplantation, and Handbook of Kidney Transplantation. She has also served as Moderator for transplant-related conferences at the American Society of Nephrology and World Congress of Nephrology, Editorial Board Member for the Case Reports in Nephrology and Transplantation Technologies and Research journals and Member of the Organizing Committee for the International Conference on Nephrology and Therapeutics.

Email: PPham@mednet.ucla.edu