Combined liver and kidney transplantation and kidney after liver transplantation in children: Indication, postoperative outcome, and long‐term results

Abstract

CLKT and sequential KALT are decided on a case-by-case basis in children for special indications such as ARPKD or PH1. We report on 21 children who underwent CLKT or KALT at our hospital between 1998 and 2013. Eleven children were diagnosed with PH1 and six with ARPKD. Other diagnosis were Joubert syndrome (n = 1), nephronophthisis (n = 1), CF (n = 1), and hepatocellular carcinoma (n = 1). Children (12 males, nine females) were aged 7.8 ± 6.2 yr (range, 10 months to 18 yr) at time of transplantation. Average wait time was 1.9 ± 0.9 yr (range, four months to 2.3 yr). Fifteen patients received dialysis prior to transplantation. In PH1 patients, four children received CLKT, five received KALT, and two infants have received only an LTx, whereas all six patients with ARPKD received CLKT. In patients with other indications, CLKT was performed in three cases and KALT in one girl. Cumulative 10-yr survival of all 21 patients was 78.4%. At the time of transfer into adult care, 13 patients retained stable liver and kidney function. Regardless the underlying diagnosis, CLKT and KALT can be performed in children with good surgical outcomes and long-term survival.

The experience of combined and sequential liver and kidney transplantation from a single living donor in patients with primary hyperoxaluria type 1

“…Most of the CLKT reports have been on cases from single deceased donors. For SLKT cases, most often one of the organs is procured from a living donor and the other from a deceased donor . Reports about CLKT and SLKT from a single living donor are limited from countries where a shortage of deceased donors remains a problem .…”

“…Therefore, LKT is the only effective treatment for PH1 because it replaces both the source (liver) and the target (kidney) of the disease. Outcomes of transplantation in PH1 have improved over time, but the choice of optimal transplantation strategy of CLKT/SLKT still remains a challenge that requires individualization in regard to stage of disease, presence of systemic oxalosis, peri‐operative risks, availability of deceased or living donors, facilities, and experience of the center …”

Hyperoxalurie primaire de type 1 : de l’enfance à l’âge adulte, comment gérer adéquatement l’adhésion au traitement médical ?

“…L'avantage d'une greffe combiné e est d'obtenir des organes d'excellente qualité et de limiter le pool antigé nique apporté par un seul donneur par rapport à une greffe sé quentielle foie puis rein. Le but est de pré venir la ré cidive de la maladie au niveau de l'allogreffe ré nale et de corriger le dé faut mé tabolique par la transplantation hé patique [19][20][21][22].…”

Health‐related quality of life after combined liver and kidney transplantation in children

“…CLKT can similarly be considered routine therapy in adults; however, CLKT in the pediatric population remains only possible in specialized centers where a highly trained multidisciplinary team is available . The diagnoses leading to this challenging procedure are often rare metabolic diseases leading to renal damage, including PH1, or diseases causing both renal and liver failure such as ARPKD . In the United States, only 166 CLKT in children had been performed from 1988 to 2007 .…”