Renal function recovery in children undergoing combined liver kidney transplants

Combined liver kidney transplant (CLKT) is a recognized treatment option for end-stage renal disease due to primary hyperoxaluria (PH-I) and cystic disorders, yet there is only limited data on posttransplant renal function recovery. The objective of this study was to assess postoperative renal function of children with PH-I (group A) undergoing CLKT and to compare this with a cohort of children (group B) who received CLKT for other indications.

Twenty-three patients underwent CLKT between 1994 and 2008 (group A: 9 patients; median age 8.6 [1.6-16.7] years; group B: 14 patients; median age 8.5 [1.9-14.6] years). The median follow-up was 88 (14-112) and 22 (4-109) months. Both groups were transplanted with comparable organs. Eight (8/9) and six (6/14) patients received preoperative renal support in each group, respectively, whereas an equal proportion of them required early postoperative renal support (4/8; 50% and 3/6; 50%, respectively). Glomerular function was significantly different between groups until first year posttransplant (median estimated glomerular filtration rate: groups A vs. B; at pretransplant, 3 mo, 6 mo, and 12 mo posttransplant, respectively; 11.06 vs. 12.61 [P=0.4], 40.78 vs. 75.83 [P=0.03], 42.59 vs. 80.56 [P=0.04] and 53.57 vs. 76.75 [P=0.005]). Overall 1-year survival is 89% versus 90% and 5-year survival is 89% versus 62%, respectively.

Children with PH-I receiving CLKT seem to have delayed recovery of renal function compared with polycystic disease, possibly due to mobilization of systemic oxalate. Consideration should be given to earlier or preemptive transplantation for children with PH-I.