In this chapter the addition of a kidney transplant to transplantation of other organs is described. The first section details the combination of pancreas with kidney transplantation for patients with diabetes mellitus and end-stage renal disease (ESRD). The next section describes the issues and controversies of adding a kidney transplant to a liver transplant. This centers on the difficulty in predicting which patients will experience recovery of kidney function. While the hepatorenal syndrome is reversible following liver transplantation, other causes of acute kidney injury, e.g., acute tubular necrosis and chronic kidney disease, are associated with significantly worse outcomes. The next section involves kidney transplantation after heart transplantation. The last section explores the influence that each organ may exert on the kidney transplant, and vice versa. There remains an important need to identify more reliable biomarkers to help differentiate reversible from irreversible kidney disease in the setting of end-stage liver and heart disease.
