Combined paediatric liver-kidney transplantation: analysis of our experience
Date
2014-08-27
Authors
Strobele, Bernd
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Abstract
Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation
of livers to this category of patient has escalated. The frequency of combined liver-kidney
transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from
those for adults and typically include rare congenital conditions; subsequently limited numbers of
this procedure have been performed in paediatric patients worldwide. Scant literature exists on the
subject.
Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric
CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the
Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted.
Results. Defining children as younger than 18 years of age, 43 patients had received a liver
transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive
polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H
deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole
liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one
kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and
included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one
in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from
6 to 65 months.
Conclusions. Although rarely indicated in children, CLKT is an effective treatment option,
appropriately utilising a scarce resource and significantly improving quality of life in the recipient.
Description
Dissertation (M.Med.(General Surgery)--University of the Witwatersrand, Faculty of Health Sciences, 2014.