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

Ranawaka, Randula; Dayasiri, Kavinda; Gamage, Manoji

doi:10.5500/wjt.v10.i10.283

Cited by 9 publications

(2 citation statements)

References 43 publications

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“…15 Long-term outcomes of pediatric CLKT depend heavily on the pre-transplant clinical condition of the child, especially in cases of rare metabolic diseases where early detection can lead to successful transplantation. 16 Additionally, even after transplantation, there may be lingering sequelae in other organs, such as central nervous or skeletal system, making CLKT not always a perfect curative treatment.…”

Section: Outcomes Of Clktmentioning

confidence: 99%

Combined liver‐kidney transplantation in pediatric patients

Yi,

Kim,

Hong

et al. 2023

Pediatric Transplantation

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Combined liver‐kidney transplantation (CLKT) is a surgical procedure that involves transplanting both liver and kidney organs. There are two types of CLKT: simultaneous liver‐kidney transplantation (smLKT) and sequential LKT (sqLKT). CLKT accounts for a small percentage of liver transplantations (LTs), particularly in pediatric cases. Nevertheless, the procedure has demonstrated excellent outcomes, with high survival rates and lower rejection rates. The main indications for CLKT in pediatric patients differ somewhat from that in adults, in which end‐stage kidney disease after LT is the major indication. In children, congenital diseases are common reason for performing CLKT; the examples of such diseases include autosomal recessive polycystic kidney disease with congenital hepatic fibrosis which equally affects both organs, and primary hyperoxaluria type 1, a primary liver disease leading kidney failure. The decision between smLKT or sqLKT depends on the dominant organ failure, the specific pathophysiology, and available organ sources. However, there remain significant surgical and societal challenges surrounding CLKT. Innovations in pharmacology and genetic engineering have decreased the necessity for CLKT in early‐diagnosed cases without portal hypertension or kidney replacement therapy. Nonetheless, these advancements are not universally accessible. Therefore, decision‐making algorithms should be crafted, considering region‐specific organ allocation systems and prevailing medical environments.

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Section: Outcomes Of Clktmentioning

confidence: 99%

Combined liver‐kidney transplantation in pediatric patients

Yi,

Kim,

Hong

et al. 2023

Pediatric Transplantation

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“…A few suggested hypotheses are that the liver absorbs the lymphocytotoxic antibodies, and that the circulating alloantibodies are neutralized by the soluble class I HLA-G antigens produced by the transplanted liver [7]. The five-year graft survival rate has been reported to be as high as 80-100% in CLKT [16,17].…”

Section: Combined Liver-kidney Transplantationmentioning

confidence: 99%

Short-Term Outcome of Isolated Kidney Transplantation in Children with Autosomal Recessive Polycystic Kidney Disease: A Case Series and Literature Review

Acharya,

Upadhyay

2023

Clinics and Practice

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Autosomal recessive polycystic kidney disease (ARPKD) is often associated with hepatobiliary disease in the form of hepatic fibrosis and/or Caroli disease. Combined liver–kidney transplantation (CLKT) is a transplant modality of choice in children with both end-stage renal disease (ESRD) and severe hepatic disease. However, there is no consensus on whether children with ARPKD-associated ESRD without severe hepatic disease can be treated with isolated kidney transplantation (KT) without the need for CLKT. We retrospectively studied the efficacy of isolated KT in children with ARPKD without severe hepatic disease, and followed the course of hepatic disease post KT. This is a single-center study of three children with ARPKD and ESRD who underwent isolated KT. None of them had severe hepatic disease at the time of KT. All children were clinically diagnosed with ARPKD in the immediate postnatal period. All had hepatic fibrosis of varying degrees and two had intrahepatic biliary duct (IHBD) dilatation. None had gastrointestinal (GI) bleed, portal hypertension or cholangitis. Two children had preemptive KT. Pre-transplant unilateral or bilateral native nephrectomy were performed for two children, and one underwent unilateral native nephrectomy at the time of KT. The median creatinine clearance at a median post-KT follow-up of 24 months was 60.3 mL/min/1.73 m2. The two-year graft and patient survival were both 100%. Post KT, all three patients continued to demonstrate evidence of hepatic fibrosis and IHBD on sonogram; however, none of them were either evaluated for or required liver transplantation given normal synthetic liver function and absence of portal hypertension or other severe hepatobiliary disease. There were no adverse events observed such as cholangitis, GI bleed, or multiorgan failure. Hence, an excellent short-term graft and patient survival was demonstrated in this study of children with ARPKD and mild to moderate hepatic disease who received isolated KT. Long-term follow-up and larger studies are important to assess the efficacy of isolated KT in this subset of children with ARPKD.

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Autosomal Recessive Polycystic Kidney Disease

Liebau

Guay‐Woodford²

2022

Pediatric Nephrology

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

Cited by 9 publications

References 43 publications

Combined liver‐kidney transplantation in pediatric patients

Combined liver‐kidney transplantation in pediatric patients

Short-Term Outcome of Isolated Kidney Transplantation in Children with Autosomal Recessive Polycystic Kidney Disease: A Case Series and Literature Review

Autosomal Recessive Polycystic Kidney Disease

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