Appendix 1: Published Guidelines on Selection Criteria for Simultaneous Liver-Kidney
Transplantation
Author
Recommendations
Davis et al. (2007) 1. Patients with CKD with CrCl (preferentially iothalamate) of ≤ 30 mL/min for >3
months
(9)
2. Patients with AKI and/or HRS on dialysis for ≥6 weeks
3. Patients with prolonged AKI with kidney biopsy showing fixed renal damage
4. SLK was not recommended in patients with AKI not requiring dialysis
Eason et al. (2008) 1. Patients with CKD with GFR ≤30 ml/min >3 months
2. Patients with AKI / HRS with SCr ≥2 mg/dL and on dialysis ≥8 weeks
(29)
3. Patients with evidence of CKD and kidney biopsy with >30% GS or 30%
fibrosis
4. Other criteria that was recommended to be considered:
 Presence of co-morbidities : Diabetes, Hypertension, age >65, renal size &
duration of Scr ≥2 mg/dL
Nadim et al. (2012) 1. Persistent AKI ≥4 weeks with one of the following:
a) Increase Scr ≥3-fold from baseline or on dialysis
(10)
b) GFR ≤35 mL/min (MDRD-6) or ≤25 mL/min (iothalamate)
3.
2. CKD ≥3 months with one of the following:
a) eGFR ≤40 mL/min (MDRD-6) or ≤ 30 mL/min (iothalamate)
b) Proteinuria ≥2 grams a day
c)
Kidney biopsy showing >30% GS or >30% interstitial fibrosis
Note: Higher GFR threshold with MDRD-6 was to account for the approximate 3040% overestimation that has been described when compared to iothalamate.
CKD, chronic kidney disease; CrCl , Creatinine clearance; HRS, hepatorenal syndrome; AKI, acute kidney
injury; SLK, Simultaneous Liver-Kidney; Scr, serum creatinine; GFR, glomerular filtration rate; GS,
glomerulosclerosis; MDRD-6, modification of diet in renal disease formula calculated using six variables
of serum creatinine, serum urea, serum albumin, age, gender
HEP-13-0912-R
Appendix 2: Equations used to estimate GFR: MDRD-4, MDRD-6, CKD-EPI (mL/min/1.73 m2)
MDRD-4 (18)
186 x (creatinine (mg/dL))-1.154x (age (year))0.203 x (0.742 if patient is female) x (1.21 if patient is
black)
MDRD-6 (19)
170 x (creatinine [mg/dL])-0.999 x (age [year])-0.176 x (0.762 if patient is female) x (1.18 if patient is
black) x (blood urea nitrogen [mmol/L])-0.17x albumin [g/dL] 0.318
CKD-EPI (20)
Black
Female, creatinine ≤62 µmol/L: 166 x (creatinine [mg/dL]/0.7) - 0.329 x (0.993) Age
Female, creatinine >62 µmol/L: 166 x (creatinine [mg/dL]/0.7) – 1.209 x (0.993) Age
Male, creatinine ≤80 µmol/L: 163 x (creatinine [mg/dL]/0.9) – 0.411 x (0.993) Age
Male, creatinine >80 µmol/L: 163 x (creatinine [mg/dL]/0.9) – 1.209 x (0.993) Age
White or other
Female, creatinine ≤62 µmol/L: 144 x (creatinine [mg/dL]/0.7) - 0.329 x (0.993) Age
Female, creatinine >62 µmol/L: 144 x (creatinine [mg/dL]/0.7) – 1.209 x (0.993) Age
Male, creatinine ≤80 µmol/L: 141 x (creatinine [mg/dL]/0.7) – 0.411 x (0.993) Age
Male, creatinine >80 µmol/L: 141 x (creatinine [mg/dL]/0.7) – 1.209 x (0.993) Age
MDRD: Modified Diet in Renal Disease
CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration
GFR: glomerular filtration rate
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