Introduction: Combined liver-kidney transplantation (ClKT) stands as an established procedure for treating end-stage diseases that concurrently affect the liver and kidneys. However, the necessity for such a procedure in pediatric patients presents as a rare scenario, consequently leading to a limited pool of experience and knowledge in this field. In this study, we contribute our own experience addressing this gap, providing an analysis of simultaneous liver-kidney transplants in children, utilizing both living and deceased adult donors.Patients A retrospective single-center study involved 28 pediatric patients who underwent CLKT between 2008 and 2023. Controls were matched to the following criteria, including age, follow-up, and similar immunosuppression regimen, achieving a 1:1 ratio for comparison. Survival analyses with Kaplan-Meier curves and log-rank tests were performed.
Results: The grafts were obtained from both living and deceased donors, and various combinations of grafts were utilized. The patients’ age ranged from 2 to 16 years (9 years ±4), while body weights varied from 9.5 to 39 kg (22 kg ±9). The follow-up period ranged from 1 to 166 months. No mortality was observed during the follow-up period. Complications greater than grade II were more common in recipients of deceased donor CLKT (21% vs 77%; P = 0.028). All patients are currently alive, with one patient requiring kidney retransplantation due to BK polyomavirus nephropathy. All living donors resumed normal life post-donation. Kidney graft survival rates for isolated kidney transplant (KT) patients were 93%, 91%, and 88% at 1, 5, and 10 years respectively (p = NS). A single acute rejection episode was noted in the CLKT group, as opposed to six episodes in the isolated KT group. A significant decline in estimated glomerular filtration rate (e-GFR) was observed in the KT group compared to the CLKT group 5-10 years post-transplant.
Conclusion: Our study affirms the efficacy and safety of CLKT for pediatric patients experiencing concurrent end-stage liver and kidney diseases. Demonstrated lower rates of rejection and improved mean e-GFR at 1, 5, and 10 years post-transplant in the CLKT group attest to the effectiveness of this approach and its potential to deliver superior long-term survival and immunological advantages. The findings, therefore, support the potential of this approach in significantly enhancing the prognosis for pediatric patients who require combined liver-kidney transplantation.