A liver or kidney transplant may be recommended in cases of severe damage to one of these organs. But if you have irreversible damage to both organs, a doctor or healthcare professional may recommend a combined liver and kidney transplant (CLKT).

In this article, we cover everything you need to know about this procedure, including why it’s recommended and how it’s done.

We also provide important information about recovery and possible complications so you’ll be able to have an informed discussion with a doctor if you’re considering this operation.

As the name suggests, a CLKT involves the removal and replacement of both the liver and kidneys. It’s primarily used in the case of multiple organ failure, but it may also be a treatment option for certain rare diseases.

Still, the procedure itself is considered relatively rare, with CLKTs representing about 8.6% of adult liver transplants and 3.1% of adult kidney transplants in the United States. In children, a CLKT consists of 2.9% of liver transplants and 2.1% of kidney transplants.

A CLKT requires the use of a healthy donor liver and kidney. While used as a treatment for certain conditions, it’s not considered a complete cure. You’ll need to take certain medications to help keep your immune system from rejecting the new organs.

A CLKT may be necessary if:

In the latter case, a CLKT can address related rare conditions such as the following:

  • Alpha-1 antitrypsin deficiency: a genetic disorder where abnormal proteins accumulate in your liver, leading to damage
  • Atypical hemolytic uremic syndrome: a rare disease characterized by low blood platelets, the destruction of red blood cells, and acute kidney failure
  • Acute intermittent porphyria: disorder that consists of enzyme deficiencies that are otherwise responsible for helping to make hemoglobin in your liver or blood marrow
  • Glycogen storage disease: affects the body’s ability to process glycogen, which may lead to hypoglycemia and possible liver damage
  • Hereditary complement C3 deficiency: a rare immunodeficiency in which low C3 plasma may lead to recurring bacterial infections
  • Homozygous protein C deficiency: a rare disorder that consists of low protein C levels, which can lead to abnormal blood clotting
  • Lecithin cholesterol acyltransferase deficiency: involves abnormal levels of free cholesterol with excess amounts being deposited in tissues throughout the body
  • Methylmalonic aciduria: a group of inherited but rare disorders that may cause an accumulation of methylmalonic acid, a substance your body normally excretes when you eat protein
  • Nephronophthisis: a type of kidney disease that may also damage the liver
  • Primary hyperoxaluria: a rare condition that causes abnormal oxalate buildup in your kidneys and other organs (a common cause for the need of CLKTs in children)

If you have end stage kidney diseases and genetic issues with your liver, a liver transplant may act as an alternative to gene therapy.

You may not be a candidate for a CLKT if you have certain conditions that might increase your risk of organ rejection. These may include substance use disorder, cancer, and other conditions that might impact your immune system, as well as lung or heart diseases.

A CLKT is done in a hospital. Before the procedure, you’ll need to have bloodwork done to ensure you’re still a “match” for the donated organs. You’ll also be placed under general anesthesia.

A kidney transplant involves the placement of a new donor kidney into your lower abdominal area and takes 3 to 4 hours to complete. The new kidney is placed underneath your existing kidneys, which may be removed if they’re found to be cancerous or increase your risk of high blood pressure.

A liver transplant is done separately and takes at least 12 hours to complete. Also, unlike the kidney transplant where your existing kidneys may be kept in place, a liver transplant always involves the removal of your existing liver.

After a CLKT, you’ll likely need to stay in the hospital for up to 2 weeks. During this time, your healthcare team will monitor your condition to make sure your transplanted organs are working properly.

You’ll also need to take medications to help lower the risk of organ rejection. These come in the form of immunosuppressants, which work by preventing your body from treating the new kidney and liver as foreign objects.

If possible, it’s important to avoid others who are sick. Taking immunosuppressants can weaken your immune system, making it harder to fight infections.

Side effects from immunosuppressants

Aside from an increased number of infections, immunosuppressant medications may also cause:

  • upset stomach
  • fever
  • burning when you urinate
  • persistent cough
  • cold-like symptoms

It’s important to take all your medications as prescribed. Don’t stop taking immunosuppressants because of side effects without speaking with a doctor first.

You should also ask a healthcare professional before taking any new drugs or supplements to prevent interactions with your current treatment plan.

A doctor will also tell you to schedule follow-up appointments. These will involve physical exams as well as blood testing to ensure that your liver and kidneys are functioning well.

Nutritional considerations after a combined kidney and liver transplant

After a CLKT, you’ll need to ensure you provide your body with the right nutrients to help aid your recovery. It’s best to eat small meals throughout the day, along with plenty of water. A doctor may also recommend taking a multivitamin.

Some people may have high potassium levels after a CLKT. If your levels are high, you may need to temporarily adopt a low-potassium diet.

To help prevent foodborne illnesses, make sure you thoroughly clean and cook all foods as appropriate and refrigerate any leftovers promptly.

You should also avoid grapefruit as well as grapefruit juice, as these may interact with immunosuppressants. Avoid drinking alcohol or using it in cooking.

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As with other major surgeries, a CLKT may carry the risk of injections and bleeding at the sites of incision. Tell a doctor right away if you’re experiencing pus or oozing at an incision site or any bleeding that doesn’t stop.

One major risk of a CLKT is organ rejection. While not as common as in previous decades, a doctor will advise you of symptoms to look out for.

Symptoms of organ rejection

Possible symptoms of an organ rejection may include the following:

  • sudden weight gain (more than 3 pounds within a couple of days)
  • fever
  • cold or flu-like symptoms
  • fatigue
  • tenderness or pain around your abdomen
  • decreased urine output
  • bloody or dark urine
  • light-colored stools
  • yellow skin or eyes (jaundice)

It’s also worth considering a doctor or outpatient center well-versed with CLKTs. This way, an experienced physician can help right away should any complications arise after the procedure.

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When considered separately, the average total cost of a kidney transplant is $442,500, and the total cost of a liver transplant is $878,400. These estimated costs also reflect prices of anesthesia, hospital stays, and postoperative care.

While coverage may vary based on company, individual, and policy, it’s likely that an insurance plan will cover a CLKT if a doctor deems the procedure medically necessary. The insurance company may require proof of prior tests, and the out-of-pocket costs will vary.

Can CLKTs be done overseas?

The short answer is yes. However, while the American Medical Association says it’s possible to gain excellent care, the organization also provides warnings about possible hazards, including personal safety, risk of infection, travel risks, and more.

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For individuals with certain rare diseases, or for those with both end stage kidney and liver failure, a CLKT can be a lifesaving treatment option. One older study from 2006 revealed a 70% average survival rate after 5 years of having the procedure.

Ironically, having a CLKT has been shown to be more effective in treating renal failure and metabolic disorders compared with either a liver or kidney transplant alone. Research also suggests that the overall success rate of a CLKT may be better if a liver transplant is done before a kidney transplantation.

While organ rejection isn’t as common, you can still help avoid this serious complication by taking your immunosuppressants as prescribed.

A CLKT is a fairly rare procedure that combines both a liver and a kidney transplant. It’s done to help address co-occurring kidney and liver diseases, as well as related rare diseases that impact the function of these organs.

It’s important to know that a CLKT is often recommended as a last resort when other treatment measures have failed.

If you qualify for a CLKT, talk with a doctor about all the potential risks as well as what you can expect after having this potentially lifesaving procedure.