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World J Transplant. Oct 18, 2020; 10(10): 283-290
Published online Oct 18, 2020. doi: 10.5500/wjt.v10.i10.283
Combined liver and kidney transplantation in children and long-term outcome
Randula Ranawaka, Kavinda Dayasiri, Manoji Gamage
Randula Ranawaka, Department of Paediatrics, Faculty of Medicine, University of Colombo and Lady Ridgeway Hospital for Children, Colombo 0094, Sri Lanka
Kavinda Dayasiri, Department of Paediatrics, Base Hospital Mahaoya, Mahaoya 0094, Sri Lanka
Manoji Gamage, Department of Clinical Nutrition, Lady Ridgeway Hospital for Children, Colombo 0094, Sri Lanka
Author contributions: Ranawaka R, Dayasiri K, Gamage M performed literature survey; Ranawaka R, Dayasiri K, Gamage M wrote the manuscript; Ranawaka R edited the final version of the manuscript. All authors read and approved the final version of the manuscript.
Conflict-of-interest statement: No conflict of interest to be declared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Randula Ranawaka, MBBS, MD, Chief Physician, Senior Lecturer, Senior Researcher, Department of Paediatrics, Faculty of Medicine, University of Colombo and Lady Ridgeway Hospital for Children, Kynsey Road, Colombo 0094, Sri Lanka. rrandula@yahoo.com
Received: July 8, 2020
Peer-review started: July 8, 2020
First decision: August 22, 2020
Revised: September 17, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 18, 2020
Abstract

Combined liver-kidney transplantation (CLKT) is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual (usually a cadaver) to the same recipient during a single surgical procedure. Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1. Atypical haemolytic uremic syndrome, methylmalonic academia, and conditions where liver and renal failure co-exists may be indications for CLKT. CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft; however, liver survival has no significant impact. Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries, acute complications are not uncommon. Bleeding, thrombosis, haemodynamic instability, infections, acute cellular rejections, renal and liver dysfunction are acute complications. The long-term outlook is promising with over 80% 5-year survival rates among those children who survive the initial six-month postoperative period.

Keywords: Combined liver-kidney transplantation, Immunoprotection, Long-term outcomes, Renal allograft survival, Acute cellular rejection, Autosomal recessive polycystic kidney disease

Core Tip: Combined liver-kidney transplantation (CLKT) is a complex surgical procedure which is increasingly performed for a number of indications, especially primary hyperoxaluria type 1 and autosomal recessive polycystic kidney disease. In CLKT, the early mortality is mostly related to infections and surgical complications of the liver graft. On the other hand, chronic complications with liver graft are fairly rare, and the liver protects the kidney allograft from rejection, which results in stable function and long term survival of the renal allograft. Long-term outcomes are promising in children who had CLKT with good overall long-term survival rates when performed in experienced centers with expertise.