Long Term Outcomes of Combined Liver Kidney Transplantation in Children with Heritable Disorders

Abstract

Introduction: Outcomes of combined liver kidney transplantation in children remains a largely unquantified yet potentially life transforming procedure for those with heritable disease. No case series assessing the impact of the CLK on patient outcome for children solely with heritable disease is available. We therefore sought to retrospectively analyse the practice in a large London quaternary centre. Methods: Children undergoing liver kidney transplantation from 2003 onwards were analysed. Indication for transplant graft types, graft survival and patient survival were recorded. Disease specific metabolic parameters were also recorded. Results: 9 children underwent liver kidney transplanation of which 7/9 were combined. All grafts in CLK group were deceased donor (1 whole liver, 1right lobe, 5 left lateral segments). The mean age was 6.8 yrs. The indication was primary type 1 hyperoxaluria (n=1), Allagile (n=1) and autosomal recessive polycystic kidney disease (n=5). The median follow up was 5213 days. 1 year and 5 year liver and kidney graft survival was 100%. Mean GFR at one year was 66.6 mls/min and last follow up was 64.4mls/min. Mean AST level at last follow up was 44. One child required re transplant at five years due to chronic liver graft rejection. All current transplant grafts were functional at last follow up. Conclusions: CLK is a safe practice in children with heritable and metabolic conditions. Excellent graft outcomes are possible. In countries where deceased donor organ pools are readily available this practice should be adopted as the mainstream of treatment.