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Combined liver-kidney transplantation in children: indications and outcome
Scott M Sutherland1, Steven R Alexander, Minnie M Sarwal
1Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. suthersm@stanford.edu
Insights
Combined liver and kidney transplantation (CLKT) offers a viable option for children with severe liver and kidney disease, particularly those with rare primary conditions or unexplained hepatic and renal failure.
Area of Science:
- Pediatric Medicine
- Nephrology
- Hepatology
- Transplantation Surgery
Background:
- Combined liver and kidney transplantation (CLKT) is an infrequent but viable procedure for pediatric patients.
- Indications include rare primary diseases affecting both organs and cases of concomitant hepatic and renal failure.
Purpose of the Study:
- To review the indications for CLKT in children.
- To analyze the outcomes following CLKT in pediatric populations.
- To address specific primary diseases and general hepatic/renal failure scenarios.
Main Methods:
- Review of existing literature and clinical data on pediatric CLKT.
- Analysis of patient cohorts undergoing CLKT for various indications.
- Evaluation of disease-specific and general failure indications.
Main Results:
- CLKT is a critical intervention for select pediatric cases.
- Outcomes are influenced by the underlying etiology of liver and kidney disease.
- The procedure addresses both primary organ diseases and secondary failure syndromes.
Conclusions:
- CLKT is an established option for children with severe, combined liver and kidney dysfunction.
- Understanding specific disease indications and general failure patterns is crucial for patient selection.
- Further research can optimize outcomes for pediatric CLKT recipients.
Abstract:
Although it remains a relatively infrequent procedure in children, CLKT has become a viable option for a select group of pediatric patients with severe liver and kidney disease. Most are performed for rare primary diseases such as PH1, but a selected few are performed in the setting of concomitant hepatic and renal failure of uncertain etiology and prognosis. This article reviews the indications for and outcomes following CLKT in children. While it focuses on the specific primary diseases which impact liver and kidney function simultaneously, it addresses the indications based on concomitant hepatic and renal failure, such as seen in the hepatorenal syndrome, as well.
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