Pediatric combined liver–kidney transplantation

Bacchetta, Justine; Mekahli, Djalila; Rivet, Christine; Demède, Delphine; Leclerc, Anne-Laure

doi:10.1097/mot.0000000000000225

Cited by 19 publications

(17 citation statements)

References 44 publications

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“…Of note, results of CLKT are today as good as for LT, and it seems that the liver protects the kidney . Many centers report fewer acute rejections in CLKT than in KT patients, which also is our experience.…”

supporting

confidence: 67%

“…This representative one‐center report underscores the difficulties encountered and the individual decisions necessary when these types of procedures are performed in children today. Only 10–30 CLKTs are performed in children worldwide annually, and the most common indications are inborn errors of metabolism of the liver affecting also the kidney (primary hyperoxaluria type 1, PH1; atypical hemolytic uremic syndrome, aHUS; and methylmalonic acidemia, MMA) or kidney diseases with liver involvement (autosomal recessive polycystic kidney disease, ARPKD) .…”

mentioning

confidence: 99%

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Combined liver and kidney transplantation: Who and when?

Holmberg

2015

Pediatric Transplantation

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supporting

confidence: 67%

mentioning

confidence: 99%

Combined liver and kidney transplantation: Who and when?

Holmberg

2015

Pediatric Transplantation

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“…Children with PH-1 develop early-onset nephrocalcinosis, nephrolithiasis and ESRD[ 16 ]. With the development of ESRD and impaired excretion, oxalate is deposited in other tissues such as the retina, blood vessels, nerves and heart[ 17 ]. PH-1 often has a variable age of onset for ESRD and oxaluria is responsive to pyridoxine in some children.…”

Section: Introductionmentioning

confidence: 99%

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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“…The most common indications for CLKT in children are primary hyperoxaluria (PH1) and autosomal recessive polycystic kidney disease (ARPKD) . Due to the low incidence of those diseases, CLKT in pediatric patients remain a scarce procedure with only about 10‐30 operations performed worldwide in specialized centers every year …”

Section: Introductionmentioning

confidence: 99%

Impact on the hepatic flow velocity after pediatric combined liver‐kidney transplantation compared to isolated pediatric liver transplantation—A matched‐pair analysis

Hellenkemper

Grabhorn

Brinkert

et al. 2019

Clinical Transplantation

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Background: Combined liver-kidney transplantation (CLKT) in children is still a rarely performed procedure. Our aim was to analyze the effect of the simultaneous transplantation of the kidney in pediatric CLKT on the liver graft flow velocity, and vascular complications compared to singular liver transplantation (LTX) in children. Methods: All pediatric CLKT performed at our institution from 1998 to 2016 were matched with singular LTX and retrospectively analyzed. Results: Overall 30 CLKT were performed in 28 children (median age 8 years, range 1-16) and matched with 30 children undergoing singular LTX (median age 7.9 years, range 1-16). No significant differences were found concerning the systolic peak flow velocity of the hepatic artery (HA) or the resistance index (RI). Vascular complications of the hepatic vessels occurred in 16.7% (CLKT) and 6.7% (LTX). The 1-/5-and 10-year patient survival was 93.3%/93.3% and 93.3% (CLKT) and 100%/100% and 92.9% (LTX). 1-/5-and 10-year liver graft survival was 76.7%/73.2% and 73.2% (CLKT) and 84.4%/75.9% and 69.6% (LTX). Conclusion: The simultaneous transplantation of the kidney in CLKT had no negative impact on hepatic flow velocity or vascular complications. Frequent Doppler ultrasound examinations, accurate volume management, and avoidance of abdominal pressure might be an explanation for the results and an excellent graft-and patient survival. K E Y W O R D S combined liver-kidney transplantation, Doppler ultrasound, hepatic flow velocity, liver transplantation, pediatric

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Pediatric combined liver–kidney transplantation

Cited by 19 publications

References 44 publications

Combined liver and kidney transplantation: Who and when?

Combined liver and kidney transplantation: Who and when?

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

Impact on the hepatic flow velocity after pediatric combined liver‐kidney transplantation compared to isolated pediatric liver transplantation—A matched‐pair analysis

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