Review of combined liver and kidney transplantation in children

Abstract

In this review, we focused on CLKT with regard to indication, results, outcome, and future developments. PH1 is one of the most common diagnoses for adult and pediatric patients qualifying for CLKT. The other major indication for combined transplantation is ARPKD. CLKT appears to be superior to sequential liver and kidney transplantation in the majority of patients and overall results following CLKT are now good, even in small children. Clinical observations suggest that there is an immunological advantage of CLKT in comparison with isolated liver or kidney transplantation. More clinical studies are necessary to identify the best candidates for CLKT while the availability of donor organs is low.

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].…”

Diagnosis and Management of Hepatobiliary Complications in Autosomal Recessive Polycystic Kidney Disease

“…Furthermore, mortality for simultaneous kidney and liver transplant is comparable to single organ transplants (19). There is immunologic advantage of simultaneous kidney liver transplant as patients are less likely to have rejection in simultaneous transplants compared to kidney transplant alone (20). Therefore, when a patient is undergoing an evaluation for isolated kidney transplant, there should be careful consideration of combined simultaneous kidney and liver transplant, particularly in those with history of cholangitis who may be at risk for recurrent cholangitis after immune suppression.…”

Combined liver and kidney transplantation in children and long-term outcome

“…It is an autosomal recessive disease and the most common indication for CLKT in children. Primary hyperoxaluria is characterized by elevated plasma and urinary oxalate levels due to the defective liver-specific perixisomal enzyme alanine/glyoxylate aminotransferase[ 14 ]. Increased accumulation of glyoxalate leads to increased oxalate and formation and deposition of insoluble calcium salts in the kidney[ 15 ].…”

“…PH-1 often has a variable age of onset for ESRD and oxaluria is responsive to pyridoxine in some children. Therefore, it is important that pyridoxine responsiveness is evaluated and DNA analysis is performed to confirm the diagnosis in all children before planning CLKT[ 14 ].…”