Renal graft outcome after combined liver and kidney transplantation in children: UCLA and UNOS experience.
Although it has been described in adults that renal grafts in the context of CLKT have a lower number of AR episodes and improved renal allograft survival, this has never been examined in pediatrics. We performed a single center retrospective case-control study examining 10 patients aged 10+/-6 yr with a CLKT that survived the post-surgery period of six months, and compared outcomes to a group of 20 KO transplants matched for age, era, and immunosuppression. We observed a significant reduction in the incidence of AR episodes in the CLKT group. To evaluate whether or not this experience was reproducible nationally, we performed an analysis of the 1995-2005 UNOS database. As of March 2007, 111 CLKT and 3798 KO transplants were identified from the OPTN/UNOS data. There was a significant improvement in the late kidney graft survival at five yr post-transplant in the CLKT group. These findings support the concept that liver transplantation is immunologically protective of the kidney allograft in CLKT.
de la Cerda
Francisco
F
Department of Pediatrics, Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA 90095-1752, USA.
Jimenez
Walter A
WA
Gjertson
David W
DW
Venick
Robert
R
Tsai
Eileen
E
Ettenger
Robert
R
D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome