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

Abstract

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.

Combined liver‐kidney transplantation in pediatric patients

“…Despite the complex procedure and relatively small sample size, CLKT demonstrates excellent outcomes. A study by Kivela et al 11 reported a remarkable five-year overall survival rate of 91%. Similarly, de la Cerda et al 12 found a five-year kidney graft survival rate of 88%, higher than that of the isolated kidney transplantation (KT) group (72.0%).…”

“…Despite the complex procedure and relatively small sample size, CLKT demonstrates excellent outcomes. A study by Kivela et al 11 . reported a remarkable five‐year overall survival rate of 91%.…”

Long-term outcome after combined or sequential liver and kidney transplantation in children with infantile and juvenile primary hyperoxaluria type 1

“…Due to the retrospective study design and the small numbers of patients we cannot answer questions regarding the frequency of rejection in comparison of isolated liver or kidney transplantation vs. CLKT. Data in adults and children have shown that the liver might "immunologically protect" the kidney after sequential and CLKT (32,33).…”

Deceased vs living donor grafts for pediatric simultaneous liver‐kidney transplantation: A single‐center experience

“…Of note, this final indication is much more commonly observed in adults rather than in children. 9 For the particular case of children with ARPKD, the indications for liver transplantation include the following: liver failure (with portal hypertension or without), recurrent cholangitis, cirrhosis (verified by biopsy), or "acute" mutations of polycystic kidney disease. 9,10 The ethical aspect of related organ donation remains controversial, especially in the case of multiorgan living donation.…”

“…9 For the particular case of children with ARPKD, the indications for liver transplantation include the following: liver failure (with portal hypertension or without), recurrent cholangitis, cirrhosis (verified by biopsy), or "acute" mutations of polycystic kidney disease. 9,10 The ethical aspect of related organ donation remains controversial, especially in the case of multiorgan living donation. 11 In pediatric practice, one of the parents of the recipient usually volunteers to become a living donor.…”