Introduction: Combined liver-kidney transplant (CLKT) is a therapeutic option in children with end-stage diseases of the kidney and liver. However, this procedure is not commonly performed and therefore there is few data on outcome of these patients. Our aim was to assess overall patient survival, graft survival (liver, kidney), as well as early and late post-transplant complications in CLKT pediatric recipients.
Methods: We analyzed medical records of 10 pediatric patients with CLKT, which was performed at a foreign expert center 2001-2024. All patients were followed up at University Children’s Hospital in Belgrade, Serbia.
Results: From 2001-2024, a total of 152 patients from University Children’s hospital underwent kidney transplantation; among them 115 (75.7%) children were transplanted in Serbia, 37 (24.3%) were transplanted abroad. Simultaneous CLKT was required and performed in 10/37 (27.3%) children, at a foreign expert center (9 in Italy, 1 in France). Indications for CLKT were nephronophthisis with liver fibrosis (n=5), primary hyperoxaluria (n=3) and autosomal recessive polycystic kidney disease (n=2). Median age was 2.25 years (IQR 0.375-7.250) at liver disease diagnosis and 2.5 years (IQR 0.375-5.875) at kidney disease diagnosis. Duration of renal replacement therapy before CLKT was 3.35±1.95 years. At the time of CLKT average age was 10.6±4.4 years, body height was 126.2±19.9 cm and body weight was 26.2±10.7 kg. Two patients underwent native kidney nephrectomy at the time of the CLKT. Six patients (60%) received a whole liver, while four (40%) received a split liver. Follow-up period from CLKT until last visit was 9±5.8 years. Early kidney-related complications occurred in 3 (30%) patients: 2 patients had delayed kidney graft function and 1 patient had kidney graft thrombosis and required a 2^nd kidney transplant. Early liver-related complications happened in 2 (20%) patients (cholangitis with bleeding and sepsis in one patient and inferior vena cava thrombosis and biliary stenosis in second patient). Apart from the child with early kidney graft thrombosis, no other patient required re-transplantation during follow up. Liver rejection was successfully treated in 3 (30%) patients, while no patient had kidney rejection. Regarding late onset complications, post-transplant lymphoproliferative disorder (PTLD) was diagnosed and successfully treated in 2 (20%) patients. Average eGFR at last visit was 65.3±33.8 ml/min/1.73m². Overall patient as well as graft survival was 100% during the follow up period.
Conclusion: In our simultaneous CLKT patient series, long-term follow up showed an excellent patient and both grafts survival. PTLD in 20% of patients was the most severe late post-transplant complication.