David Cha1, Katherine Concepcion2, Amy Gallo1 and Waldo Concepcion1*
1Department of Multi Organ Transplantation, Stanford University School of Medicine, USA
2Department of Surgery, Loma Linda University School of Medicine, USA
Combined liver and kidney transplants (CLKTs) are not commonly performed in pediatric patients. Advancing the medical community’s understanding of when these procedures may be the optimal choice for pediatric patients and when other options may be preferable is crucial. There are three main pediatric groups who may be considered candidates for CLKT: (1) those who suffer a disease that leads to irreversible liver and kidney damage‒including autosomal recessive polycystic kidney disease; (2) those with end-stage renal disease caused by a liver-based metabolic disease‒ including primary hyperoxaluria types 1 and 2, methylmalonic acidemia, and atypical hemolytic uremic syndrome; and (3) those who present with concomitant liver and kidney failure‒including patients with Boichis syndrome (nephronophthisis plus congenital hepatic fibrosis) or with liver tumor plus nephrotoxicity. We review here the indications and special considerations related to CLKT for patients in each of these groups and the outcomes seen to date in these pediatric patient groups. With the appropriate donor selection, family education, and medical team commitment CLKT has been shown to be and, we believe, will continue to be an outstanding option for medical management in this select group of patients. Continued advances pre-transplant, intra-operatively and post-transplant will be required to optimize success.
Combined liver kidney transplantation; Simultaneous liver kidney transplantation; Autosomal recessive polycystic kidney disease; Primary hyperoxaluria, methylmalonic acidemia; Atypical hemolytic uremic syndrome; Boichis syndrome, Concomitant liver and kidney failure
Cha D, Concepcion K, Gallo A, Concepcion W. Combined Liver Kidney Transplantation in Pediatrics: Indications, Special Considerations, and Outcomes. Clin Surg. 2017; 2: 1352.