Combined liver and kidney transplantation in children

Background. Preexisting renal dysfunction has been reported to significantl y increase the morbidity and mortality associated with orthotopic liver tra nsplantation (OLT). OLT alone has been recommended for adults and children with end-stage liver disease and reversible causes of renal failure (i.e., hepatorenal syndrome), whereas combined liver and kidney transplantation (L KT) has been shown to be an effective treatment for adults with combined en d-stage liver and kidney disease. The purpose of this study was to examine the role of LKT in children. Methods. Between October of 1984 and 1997, 385 children less than 18 years of age underwent OLT at the University of Chicago. During this same time pe riod 12 patients underwent LKT, Data were gathered by retrospective review of the patients medical records and by interviews conducted with the patien ts' families. Results. Actuarial patient survival was comparable for children who underwe nt OLT alone and LKT (69% versus 67% at 5 years). All allograft losses in t he LKT group were the result of patient death and occurred within the first 90 postoperative days. Factors associated with decreased patient survival included severity of illness as reflected by United Network of Organ Sharin g status and LKT after failed OLT or cadaveric renal transplant. Conclusions, In children with concomitant endstage Ii ver and kidney diseas e, LKT can be considered an effective therapeutic option in selected patien ts. Long-term patient survival in patients undergoing LKT is comparable to that of patients with normal renal function undergoing OLT alone.