Successful long-term outcome of pediatric liver–kidney transplantation: a single-center study

Bernabeu, Jesús Quintero; Juampérez, Javier; Muñoz, Marina; Rodriguez, Olalla; Vilalta, R.; Molino, Jose Andrés; Asensio, M; Bilbao, Itxarone; Ariceta, Gema; Rodrigo, Carlos; Charco, Ramón

doi:10.1007/s00467-017-3782-5

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Our long‐term results of eGFR are better or comparable to other pediatric CLKT single‐center studies . In two of these studies, eGFR was around 70 mL/min/1.73 m 2 at last evaluation with varying follow‐up times .…”

Section: Discussionsupporting

confidence: 75%

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Renal function after combined liver‐kidney transplantation: A longitudinal study of pediatric and adult patients

Kivelä

Lempinen

Holmberg

et al. 2019

Pediatric Transplantation

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It has been proposed that the liver protects the kidney in CLKT. However, few studies have examined long‐term renal function after CLKT and contrasted renal function of CLKT patients to KT patients beyond one year after transplantation. We studied long‐term renal function of CLKT patients and compared renal function of CLKT patients to KT patients between one and five years after transplantation. Patients who underwent CLKT between 1993 and 2011 were included (n = 34; 11 children and 23 adults). Ninety‐six (27 children and 69 adults) KT patients were selected as controls. GFR was estimated (eGFR) and measured (mGFR) with 51Cr‐EDTA clearance. Mean mGFR was 63 at one and 70 at ten years after pediatric CLKT. Mean eGFR was 75 at one and 50 at ten years after adult CLKT. Difference in mean mGFR between pediatric CLKT and KT patients was 8 (95% CI −7 to 23) and 11 (95% CI −4 to 26) at one and five years after transplantation, respectively. Difference in mean eGFR between adult CLKT and KT patients was 8 (95% CI −5 to 20) and 1 (95% CI −10 to 12) at one and five years after transplantation, respectively. Longitudinal changes in GFRs were somewhat similar in CLKT and KT patients in both age‐groups but pediatric CLKT patients had on average higher GFRs than pediatric KT patients. In long‐term follow‐up, renal function remains stable in pediatric CLKT patients but declines in adult CLKT patients.

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Section: Discussionsupporting

confidence: 75%

“…However, the follow‐up times were, on average, shorter than in our cohort. In two other studies, there was a 13 to 18 mL/min/1.73 m 2 drop in eGFR from one to ten years after CLKT . In contrast, we observed some improvement in eGFR from one to ten years.…”

Section: Discussioncontrasting

confidence: 57%

Renal function after combined liver‐kidney transplantation: A longitudinal study of pediatric and adult patients

Kivelä

Lempinen

Holmberg

et al. 2019

Pediatric Transplantation

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“…The investigators observed a statistically significant greater decline of estimated glomerular filtration rate in isolated kidney transplant patients compared to those who had CLKT whilst acute rejection was less in those with CLKT. The investigators observed better outcomes in those with ARPKD compared to PH-1 and comparative to observations made by Quintero Bernabeu et al [ 41 ] Although there are several studies which reported long term renal outcomes, only a few studies reported long term liver outcomes of which 5-year graft survival varied from 76.5%[ 32 ]-80%32[ 34 ].…”

Section: Introductionmentioning

confidence: 78%

“…Improved renal outcomes from such immunoprotection in part explain the fact that CLKT has better outcomes as compared with sequential organ transplantation in patients with combined liver and renal impairment. Liver rejection rates were not different in those with CLKT when compared to isolated liver transplantations[ 41 ]. Rapamycin, a calcineurin inhibitor, is the mainstay of immunosuppression following CKLT.…”

Section: Introductionmentioning

confidence: 99%

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

Ranawaka¹,

Dayasiri²,

Gamage³

2020

WJT

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Combined liver-kidney transplantation (CLKT) is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual (usually a cadaver) to the same recipient during a single surgical procedure. Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1. Atypical haemolytic uremic syndrome, methylmalonic academia, and conditions where liver and renal failure co-exists may be indications for CLKT. CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft; however, liver survival has no significant impact. Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries, acute complications are not uncommon. Bleeding, thrombosis, haemodynamic instability, infections, acute cellular rejections, renal and liver dysfunction are acute complications. The long-term outlook is promising with over 80% 5-year survival rates among those children who survive the initial six-month postoperative period.

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Long-term kidney and liver outcome in 50 children with autosomal recessive polycystic kidney disease

et al. 2020

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Successful long-term outcome of pediatric liver–kidney transplantation: a single-center study

Abstract: Long-term results of liver-kidney transplants in children are encouraging, being comparable with those obtained in isolated liver transplantation.

Cited by 6 publications

References 31 publications

Renal function after combined liver‐kidney transplantation: A longitudinal study of pediatric and adult patients

Renal function after combined liver‐kidney transplantation: A longitudinal study of pediatric and adult patients

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

Long-term kidney and liver outcome in 50 children with autosomal recessive polycystic kidney disease

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