Coexisting end stage liver disease (ESLD) and end stage renal disease (ESRD) for a patient on dialysis is a standard indication for a combined liver-kidney transplantation (CLKT). A survival advantage after CLKT has been verified in liver transplant candidates with significant kidney dysfunction due to chronic kidney disease (CKD) or acute kidney injury (AKI). The severity (glomerular filtration rate (GFR) < or =30 mL/min) and duration (more than 8~12 weeks) of kidney dysfunction are strong determinants for the selection of CLKT candidates. The CLKT patient survival rate is superior to that of liver transplant alone in candidates with a serum creatinine >2.0 mg/dL or who are on dialysis. Because of the immunological modulation effect of the liver graft, post-transplant CLTX results in a lower incidence of acute rejection and higher long-term censored graft survival rate in kidney transplant recipients. Despite the advantages of CLKT, the CLKT waiting list is extremely rare in Korea (0.80%, 67/3,717, from recent Korean Network for Organ Sharing (KONOS) data on March 2010). The narrow indications for CLKT (only ESRD candidates on dialysis are accepted for CLKT) and inferior ranking of CLKT for kidney allocation is a pitfall of the multi-organ allocation rule in KONOS.
Acute Kidney Injury ; Creatinine ; Dialysis ; End Stage Liver Disease ; Filtration ; Graft Survival ; Humans ; Imidazoles ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Liver ; Nitro Compounds ; Rejection (Psychology) ; Renal Insufficiency, Chronic ; Survival Rate ; Transplants ; Waiting Lists

In Malaysia, dialysis-treated end stage renal disease (ESRD) patients have been increasing rapidly. Haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) use a disproportionately large amount of limited healthcare resources. This study aims to estimate the costs of HD and CAPD from the Ministry of Health (MOH) perspective. One year prospective multicentre study was conducted from October 2016 to September 2017 to assess direct medical costs of 90 HD patients and 73 CAPD patients from five large MOH dialysis centres. A mixed method of activity-based costing and step-down was used. The capital costs included land, building, medical equipment and furnishing. The recurrent costs included staff emoluments, facility utilities, patients’ medical costs and dialysis consumables. One-way sensitivity analysis was performed to investigate variability in the data. One hundred and forty-one patients (82%) completed the study comprising of 77 patients on HD and 64 patients on CAPD. Majority of the patients were between 46-65 years old (n=75, 53.2%). The most common aetiology of ESRD was diabetes mellitus (44.2% in HD and 48.4% in CAPD). Cost per patient per year was RM39,790 for HD and RM37,576 for CAPD. The main cost drivers were staff emoluments (37.6%) and dialysis consumables (70.5%) for HD and CAPD respectively. HD is highly sensitive towards all the variables analysed except for dialysis consumables. In CAPD, there are minimal sensitivities except for the 5% discount rate. Knowledge of the costs of modalities are useful in the context of planning for dialysis services and to optimise the number of kidney failure patients treated by dialysis within the MOH.
Haemodialysis ; continuous ambulatory peritoneal dialysis ; end stage renal disease ; cost ; Malaysia

In cases of acute liver failure or acute or chronic liver failure, extracorporeal albumin dialysis utilizing a Molecular Adsorbent Recirculating System has been used to treat liver failure and to reduce serum total bilirubin concentrations as a bridge therapy until either liver transplantation or spontaneous recovery. However, the procedure is expensive and is not easily administered in clinical practice. Recently, single pass albumin dialysis (SPAD) using continuous renal replacement therapy was introduced, but information is scarce regarding its efficacy in controlling serum bilirubin. The authors report a case of acute hepatitis A, in which SPAD was performed to correct severe hyperbilirubinemia.
Bilirubin ; Dialysis ; End Stage Liver Disease ; Formaldehyde ; Hepatitis ; Hepatitis A ; Hyperbilirubinemia ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Polymers ; Renal Dialysis ; Renal Replacement Therapy ; Resorcinols

BACKGROUND: High model for end-stage liver disease (MELD) scores (> or =35) is closely associated with poor posttransplantation outcomes in patients who undergo living donor liver transplantation (LDLT). There is little information regarding factors that negatively impact the survival of patients with high MELD scores. The aim of this study was to identify factors associated with 3-month mortality of patients after LDLT. METHODS: We retrospectively analyzed 774 patients who underwent adult LDLT with right lobe grafts between 1996 and 2012. Exclusion criteria were re-transplantation, left graft, auxiliary partial orthotopic liver transplantation, and inadequate medical recording. Preoperative variables were analyzed retrospectively. RESULTS: The overall 3-month survival rate was 92%. In univariate analysis, acute progression of disease, severity of hepatic encephalopathy, Child-Pugh class C, hepatorenal syndrome, use of continuous renal replacement therapy, use of ventilator, intensive care unit (ICU) care before transplantation, and MELD scores > or =35 were identified as potential risk factors. However, only ICU care before transplantation and MELD scores > or =35 were independent risk factors for 3-month mortality after LDLT. Three-month and 1-year patient survival rates for those with no risk factors were 95.5% and 88.6%, respectively. In contrast, patients with at least one risk factor had 3-month and 1-year patient survival rates of 88.4% and 81.1%, respectively, while patients with two risk factors had 3-month and 1-year patient survival rates of 55.6% and 55.6%, respectively. CONCLUSIONS: Patients with both risk factors (ICU care before LDLT and MELD scores > or =35) should be cautiously considered for treatment with LDLT.
Adult ; End Stage Liver Disease ; Hepatic Encephalopathy ; Hepatorenal Syndrome ; Humans ; Intensive Care Units ; Liver Diseases ; Liver Transplantation* ; Living Donors* ; Medical Records ; Mortality* ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Survival Rate ; Transplants ; Ventilators, Mechanical

No abstract available.
Kidney Failure, Chronic*

No abstract available.
Creatinine* ; Kidney Failure, Chronic*

No abstract available.
Humans ; Kidney Failure, Chronic*

No abstract available.
Kidney Failure, Chronic* ; Tuberculosis*

No abstract available.
Kidney Failure, Chronic*

No abstract available.
Hyperhomocysteinemia* ; Kidney Failure, Chronic*