A Case of Recovery of Native Kidney Function Years after Simultaneous Liver-Kidney Transplant

Introduction: Simultaneous Liver-Kidney (SLK) transplantation is often considered in End Stage Liver Disease (ESLD) patients with significant renal dysfunction. Prior to the implementation of the Organ Procurement and Transplantation Network’s (OPTN) 2017 policy on SLK allocation, criteria were variable and of particular concern was the potential recovery of native renal function following SLK. Here we describe a case of a patient who underwent an SLK transplant and was found to have native renal recovery eight years later. Case Description: A 45-year-old female with ESLD due to autoimmune hepatitis who underwent liver transplant in 2009 with subsequent failure and resulting hepatorenal syndrome (HRS) followed by SLK in 2015 presented to the hospital after unintentional acetaminophen overdose complicated by acute kidney injury (AKI). Ultrasound of her kidney graft showed severe atrophy with a lack of renal cortex blood flow despite patent vessels. She briefly required dialysis for uremia followed by rapid renal recovery. A nuclear medicine (NM) study using Tc99m MAG3 was later performed which found functioning native kidneys with minimal activity in the kidney graft. Immunosuppression decisions were deferred to the liver transplant service in the setting of kidney graft loss. Discussion: Native renal recovery following SLK is a known phenomenon particularly in patients with HRS. NM studies are more commonly done in the post-SLK period and are not usually considered years after SLK. This case features a patient who received an SLK prior to the 2017 SLK policy updates and who was found eight years later to have renal graft loss with recovery of native renal function. Reviewing this patient’s pre-transplant data shows she would not have been an SLK candidate under current criteria. This case illustrates the importance of careful policy decisions regarding SLK allocation.