Skip to main content
SpringerLink
Log in

Combined liver and kidney transplantation in children: analysis of renal graft outcome

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

Abstract

Background

Combined liver–kidney transplantation (CLKT) is the accepted treatment for patients with both liver failure and progressive renal insufficiency. Long-term outcome data for CLKT in children is sparse and controversy exists as to whether simultaneous CLKT with organs from the same donor confers immunologic and survival benefit to the kidney allograft. We report the long-term renal graft outcomes of 40 patients who had simultaneous CLKT.

Methods

A retrospective analysis of kidney graft survival (time from transplantation to death, return to dialysis or last follow-up event) in all pediatric patients (age < 18 years old) who underwent CLKT from March 1994 to January 2015. A 1:1 ratio of controls (deceased donor kidney recipients from our centre matched for age (±2 years) at transplant, time from transplant (±1 year) and treated with the same immunosuppressive regime) to cases was used to compare outcome. Estimated glomerular filtration rate (e-GFR) was calculated using the Schwartz formula. Survival curves were determined using Kaplan–Meier analysis.

Results

The kidney graft survival for CLKT patients was 87.4, 82, and 82 % at 1, 5, and 10 years; kidney graft survival for isolated KT patients were 97.2, 93, and 93 % at 1, 5, and 10 years (p = NS). There were two acute rejection episodes (5 %) in the CLKT group compared to five (12.5 %) episodes in the isolated KT group. There was no statistically significant difference in e-GFR at 1, 5, and 10 years in the two groups but there was a statistically significantly greater decline in e-GFR in the KT group compared to CLKT group from 5–10 years following transplant.

Conclusions

There are fewer acute rejection episodes following CLKT compared to isolated KT, and we noted a higher mean e-GFR at 1, 5, and 10 years with significantly lesser decline in e-GFR from 5 to 10 years in the CLKT group.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

  2. Margreiter R, Kramar R, Huber C, Steiner E, Niederwieser D, Judmaier G, Vogel W (1984) Combined liver and kidney transplantation. Lancet 1:1077–1078

    Article  CAS  PubMed  Google Scholar 

  3. Sutherland SM, Alexander SR, Sarwal MM, Berquist CW (2008) Combined liver–kidney transplantation in children: Indications and outcome. Pediatr Transplant 12:835–846

  4. Opelz G, Margreiter R, Dohler B (2002) Prolongation of long-term kidney graft survival by a simultaneous liver transplant: the liver does it, and the heart does it too. Transplantation 74:1390–1394

    Article  PubMed  Google Scholar 

  5. Ruiz R, Kunitake H, Wilkinson AH, Danovitch GM, Farmer DG, Ghobrial RM, Yersiz H, Hiatt JR, Busuttil RW (2006) Long-term analysis of combined liver and kidney transplantation at a single centre. Arch Surg 141:735–741

    Article  PubMed  Google Scholar 

  6. Creput C, Durrbach A, Samuel D, Eschwege P, Amor M, Kriaa F, Kreis H, Benoit G, Bismuth H, Charpentier B (2003) Incidence of renal and liver rejection and patient survival rate following combined liver and kidney transplantation. Am J Transplant 3:348–356

    Article  PubMed  Google Scholar 

  7. Millan MT, Berquist WE, So SK, Sarwal MM, Wayman KI, Cox KL, Filler G, Salvatierra O Jr, Esquivel CO (2003) One hundred percent patient and kidney allograft survival with simultaneous liver and kidney transplantation in infants with primary hyperoxaluria: a single-centre experience. Transplantation 76:1458–1463

    Article  PubMed  Google Scholar 

  8. Ettenger RB, Blifeld C, Prince H, Gradus DB, Cho S, Sekiya N, Salusky IB, Fine RN (1987) The paediatric nephrologists’ dilemma: growth after renal transplantation and its interaction with age as a possible immunologic variable. J Pediatr 111:1022–1025

    Article  CAS  PubMed  Google Scholar 

  9. Calinescu AM, Wildhaber BE, Poncet A, Toso C, McLin VA (2014) Outcomes of liver–kidney transplantation in children: analysis of the scientific registry of transplant recipients. Am J Transplant 14(12):2861–2868

    Article  CAS  PubMed  Google Scholar 

  10. Gjertson DW, Cecka JM (2001) Determinants of long-term survival of paediatric kidney grafts reported to the United Network for Organ Sharing kidney transplant registry. Pediatr Transplant 5:5–15

    Article  CAS  PubMed  Google Scholar 

  11. Bisigniano L, Lopez-Rivera A, Tagliafichi V, Fernandez V, Soratti C (2012) Factors associated with patient and graft survival using kidneys from cadaveric donors in transplanted patients over 18 years of age in Argentina. Transplant Proc 44:2242–2245

    Article  CAS  PubMed  Google Scholar 

  12. Perera MT, Silva MA, Sharif K, McKiernan PJ, Kelly DA, Lloyd C, Milford DV, Mayer DA, Mirza DF (2009) Improved outcomes of combined liver and kidney transplants in small children (<15 kg). Transplantation 88:711–715

    Article  PubMed  Google Scholar 

  13. Jamieson NV (2005) A 20-year experience of combined liver/kidney transplantation for primary hyperoxaluria (PH1): The European PH1 transplant registry experience 1984–2004. Am J Nephrol 25:282–289

    Article  PubMed  Google Scholar 

  14. Ellis SR, Hulton SA, McKiernan PJ, de Ville de Goyet J, Kelly DA (2001) Combined liver–kidney transplantation for primary hyperoxaluria type 1 in young children. Nephrol Dial Transplant 16:348–354

    Article  CAS  PubMed  Google Scholar 

  15. De la Cerda F, Jimenez WA, Gjertson DW, Venick R, Tsai E, Ettenger R (2010) Renal graft outcome after combined liver and kidney transplantation in children: UCLA and UNOS experience. Pediatr Transplant 14:459–464

    Article  PubMed  Google Scholar 

  16. Rasmussen A, Davies HF, Jamieson NV, Evans DB, Calne RY (1995) Combined transplantation of liver and kidney from the same donor protects the kidney from rejection and improves kidney graft survival. Transplantation 59:919–921

    Article  CAS  PubMed  Google Scholar 

  17. 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 76:348–353

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. P. Davies for providing statistical advice and analysis, Dr. L. Kerecuk for providing outcome data for isolated kidney transplants and colleagues in the Departments of Hepatology and Nephrology who contributed to the success of this programme.

Author information

Authors and Affiliations

  1. Departments of Nephrology, Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK

    Randula Ranawaka, Sally A. Hulton & David V. Milford

  2. Departments of Hepatology, Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK

    Carla Lloyd, Pat J. McKiernan & Khalid Sharif

Authors
  1. Randula Ranawaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carla Lloyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pat J. McKiernan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sally A. Hulton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khalid Sharif
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David V. Milford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Randula Ranawaka.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ranawaka, R., Lloyd, C., McKiernan, P.J. et al. Combined liver and kidney transplantation in children: analysis of renal graft outcome. Pediatr Nephrol 31, 1539–1543 (2016). https://doi.org/10.1007/s00467-016-3396-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-016-3396-3

Keywords

Search

Navigation