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

© 2017, IPNA. Introduction: Liver–kidney transplantation is a rare procedure in children, with just ten to 30 cases performed annually worldwide. The main indications are autosomal recessive polycystic liver–kidney disease and primary hyperoxaluria. This study aimed to report outcomes of liver–kidney transplantation in a cohort of pediatric patients. Methods: We retrospectively analyzed all pediatric liver–kidney transplantations performed in our center between September 2000 and August 2015. Patient data were obtained by reviewing inpatient and outpatient medical records and our transplant database. Results: A total of 14 liver–kidney transplants were performed during the study period, with a median patient age and weight at transplant of 144.4 months (131.0–147.7) and 27.3 kg (12.0–45.1), respectively. The indications for liver–kidney transplants were autosomal recessive polycystic liver–kidney disease (8/14), primary hyperoxaluria −1 (5/14), and idiopathic portal hypertension with end-stage renal disease (1/14). Median time on waiting list was 8.5 months (5.7–17.3). All but two liver–kidney transplants were performed simultaneously. Patients with primary hyperoxaluria-1 tended to present a delayed recovery of renal function compared with patients transplanted for other indications (62.5 vs 6.5 days, respectively, P 0.076). Patients with liver–kidney transplants tended to present a lower risk of acute kidney rejection than patients transplanted with an isolated kidney transplant (7.2% vs 32.7%, respectively; P < 0.07). Patient and graft survival at 1, 3, and 5 years were 100%, 91.7%, 91.7%, and 91.7%, 83.3%, 83.3%, respectively. No other grafts were lost. Conclusion: Long-term results of liver–kidney transplants in children are encouraging, being comparable with those obtained in isolated liver transplantation.