Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Davis CL, Feng S, Sung R, Wong F, Goodrich NP, Melton LB, Reddy KR, Guidinger MK, Wilkinson A, Lake J (2007) Simultaneous liver–kidney transplantation: evaluation to decision making. Am J Transplant 7(7):1702–1709

    Article  CAS  PubMed  Google Scholar 

  2. Eason JD, Gonwa TA, Davis CL, Sung RS, Gerber D, Bloom RD (2008) Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK). Am J Transplant 8(11):2243–2251

    Article  CAS  PubMed  Google Scholar 

  3. Freeman RB, Wiesner RH, Harper A, SV MD, Lake J, Edwards E, Merion R, Wolfe R, Turcotte J, Teperman L, UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN (2002) The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl 8(9):851–858

    Article  PubMed  Google Scholar 

  4. Jalanko H, Pakarinen M (2014) Combined liver and kidney transplantation in children. Pediatr Nephrol 29(5):805–814 quiz 812

    Article  PubMed  Google Scholar 

  5. Otte JB (2002) History of pediatric liver transplantation. Where are we coming from? Where do we stand? Pediatr Transplant 6(5):378–387

    Article  CAS  PubMed  Google Scholar 

  6. Burdelski M, Nolkemper D, Ganschow R, Sturm E, Malago M, Rogiers X, Brölsch CE (1999) Liver transplantation in children: long-term outcome and quality of life. Eur J Pediatr 58(Suppl 2):S34–S42

    Article  Google Scholar 

  7. Chava SP, Singh B, Pal S, Dhawan A, Heaton ND (2009) Indications for combined liver and kidney transplantation in children. Pediatr Transplant 13(6):661–669

    Article  PubMed  Google Scholar 

  8. Gao A, Cachat F, Faouzi M, Bardy D, Mosig D, Meyrat BJ, Girardin E, Chehade H (2013) Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. Kidney Int 83(3):524–530

    Article  CAS  PubMed  Google Scholar 

  9. Demetris A, Adams D, Bellamy C, Blakolmer K, Clouston A, Dhillon AP, Fung J, Gouw A, Gustafsson B, Haga H, Harrison D, Hart J, Hubscher S, Jaffe R, Khettry U, Lassman C, Lewin K, Martinez O, Nakazawa Y, Neil D, Pappo O, Parizhskaya M, Randhawa P, Rasoul-Rockenschaub S, Reinholt F, Reynes M, Robert M, Tsamandas A, Wanless I, Wiesner R, Wernerson A, Wrba F, Wyatt J, Yamabe H (2000) Update of the international Banff schema for liver allograft rejection: working recommendations for the histopathologic staging and reporting of chronic rejection. An international panel. Hepatology 31(3):792–799

    Article  CAS  PubMed  Google Scholar 

  10. Taner T, Gandhi MJ, Sanderson SO, Poterucha CR, De Goey SR, Stegall MD, Heimbach JK (2012) Prevalence, course and impact of HLA donor-specific antibodies in liver transplantation in the first year. Am J Transplant 12(6):1504–1510

    Article  CAS  PubMed  Google Scholar 

  11. Gloor JM, DeGoey S, Ploeger N, Gebel H, Bray R, Moore SB, Dean PG, Stegall MD (2004) Persistence of low levels of alloantibody after desensitization in crossmatch-positive living-donor kidney transplantation. Transplantation 78(2):221–227

    Article  CAS  PubMed  Google Scholar 

  12. Marfo K, Lu A, Ling M, Akalin E (2011) Desensitization protocols and their outcome. Clin J Am Soc Nephrol 6(4):922–936

    Article  PubMed  Google Scholar 

  13. Margarit C, Lázaro JL, Hidalgo E, Balsells J, Murio E, Charco R, Revhaug A, Mora A, Cortés C (1998) Cross-clamping of the three hepatic veins in the piggyback technique is a safe and well tolerated procedure. Transpl Int 11(Suppl 1):S248–S250

    Article  PubMed  Google Scholar 

  14. Bueno J, Escartín A, Balsells J, Margarit C (2007) Intraoperative flow measurement of native liver and allograft during orthotopic liver transplantation in children. Transplant Proc 39(7):2278–2279

    Article  CAS  PubMed  Google Scholar 

  15. Chava SP, Singh B, Stangou A, , Battula N, Bowles M, O’Grady J, Rela M, Heaton ND (2010) Simultaneous combined liver and kidney transplantation: a single center experience. Clin Transpl 24(3):E62-E68

    Article  Google Scholar 

  16. Cochat P, Groothoff J (2013) Primary hyperoxaluria type 1: practical and ethical issues. Pediatr Nephrol 28(12):2273–2281

    Article  PubMed  Google Scholar 

  17. Perera MT, McKiernan PJ, Sharif K, Milford DV, Lloyd C, Mayer DA, Kelly DA, Mirza DF (2009) Renal function recovery in children undergoing combined liver kidney transplants. Transplantation 87(10):1584–1589

    Article  PubMed  Google Scholar 

  18. Shapiro R, Weismann I, Mandel H, Eisenstein B, Ben-Ari Z, Bar-Nathan N, Zehavi I, Dinari G, Mor E (2001) Primary hyperoxaluria type 1: improved outcome with timely liver transplantation: a single-center report of 36 children. Transplantation 72(3):428–432

    Article  CAS  PubMed  Google Scholar 

  19. Cochat P, Liutkus A, Fargue S, Basmaison O, Ranchin B, Rolland M-O (2006) Primary hyperoxaluria type 1: still challenging! Pediatr Nephrol 21(8):1075–1081

    Article  PubMed  Google Scholar 

  20. Fong T-L, Bunnapradist S, Jordan SC, Selby RR, Cho YW (2003) Analysis of the united network for organ sharing database comparing renal allografts and patient survival in combined liver–kidney transplantation with the contralateral allografts in kidney alone or kidney-pancreas transplantation. Transplantation 76(2):348–353

    Article  PubMed  Google Scholar 

  21. Simpson N, Cho YW, Cicciarelli JC, Selby RR, Fong T-L (2006) Comparison of renal allograft outcomes in combined liver–kidney transplantation versus subsequent kidney transplantation in liver transplant recipients: analysis of UNOS database. Transplantation 82(10):1298–1303

    Article  PubMed  Google Scholar 

  22. Kniepiess D, Iberer F, Grasser B, Schaffellner S, Tscheliessnigg KH (2003) Sirolimus and mycophenolate mofetil after liver transplantation. Transpl Int 16:504–509

    Article  Google Scholar 

  23. Chapal M, Debout A, Dufay A, Salomon R, Roussey G, Burtey S, Launay EA, Vigneau C, Blancho G, Loirat C, Hourmant M, Fakhouri F (2012) Kidney and liver transplantation in patients with autosomal recessive polycystic kidney disease: a multicentric study. Nephrol Dial Transplant 27(5):2083–2038

    Article  PubMed  Google Scholar 

  24. Khan K, Schwarzenberg SJ, Sharp HL, Matas AJ, Chavers BM (2002) Morbidity from congenital hepatic fibrosis after renal transplantation for autosomal recessive polycystic kidney disease. Am J Transplant 2(4):360–365

    Article  PubMed  Google Scholar 

  25. Ueno T, Barri YM, Netto GJ, Martin A, Onaca N, Sanchez EQ, Chinnakotla S, Randall HB, Dawson S, Levy MF, Goldstein RM, Klintmalm GB (2006) Liver and kidney transplantation for polycystic liver and kidney-renal function and outcome. Transplantation 82(4):501–507

    Article  CAS  PubMed  Google Scholar 

  26. Srinath A, Shneider BL (2012) Congenital hepatic fibrosis and autosomal recessive polycystic kidney disease. J Pediatr Gastroenterol Nutr 54(5):580–587

    Article  PubMed  PubMed Central  Google Scholar 

  27. Shneider BL, Magid MS (2005) Liver disease in autosomal recessive polycystic kidney disease. Pediatr Transplant 9(5):634–639

    Article  PubMed  Google Scholar 

  28. Davis ID, Ho M, Hupertz V, Avner ED (2003) Survival of childhood polycystic kidney disease following renal transplantation: the impact of advanced hepatobiliary disease. Pediatr Transplant 7(5):364–369

    Article  PubMed  Google Scholar 

  29. Brinkert F, Lehnhardt A, Montoya C, Helmke K, Schaefer H, Fischer L, Nashan B, Bergmann C, Ganschow R, Kemper MJ (2013) Combined liver–kidney transplantation for children with autosomal recessive polycystic kidney disease (ARPKD): indication and outcome. Transpl Int 26(6s):640–650

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study did not receive any financial support.

Author information

Authors and Affiliations

  1. Pediatric Hepatology and Liver Transplant Unit, Hospital Universitari Vall d’Hebron, Universitat Atònoma de Barcelona, 08035, Barcelona, Spain

    Jesús Quintero Bernabeu & Javier Juamperez

  2. Pediatric Nephrology Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain

    Marina Muñoz, Ramon Vilalta & Gema Ariceta

  3. Pediatrics Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain

    Olalla Rodriguez & Carlos Rodrigo

  4. Pediatric Surgery Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain

    José A. Molino & Marino Asensio

  5. HPB Surgery and Transplants, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain

    Itxarone Bilbao & Ramón Charco

Authors
  1. Jesús Quintero Bernabeu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Juamperez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marina Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olalla Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ramon Vilalta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José A. Molino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marino Asensio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Itxarone Bilbao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gema Ariceta
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carlos Rodrigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ramón Charco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jesús Quintero Bernabeu.

Ethics declarations

Informed consent was obtained from all participants. The study was reviewed and approved by the Ethics Committee of our center.

Conflict of interest

The authors declare that they have no conflict of interest.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Additional information

This article is part of the topical collection on “What’s New in Renal Transplantation?”

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Quintero Bernabeu, J., Juamperez, J., Muñoz, M. et al. Successful long-term outcome of pediatric liver–kidney transplantation: a single-center study. Pediatr Nephrol 33, 351–358 (2018). https://doi.org/10.1007/s00467-017-3782-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-017-3782-5

Keywords

Search

Navigation