title: Immediate postoperative intensive care treatment of pediatric combined liver-kidney transplantation: outcome and prognostic factors.
abstract: BACKGROUND
  Studies reporting the immediate pediatric intensive care unit (PICU) treatment after combined liver-kidney transplantation (CLKT) are scarce, although this period is pivotal for survival and long-term outcome.
  
  
  METHODS
  We retrospectively analyzed all pediatric CLKT performed in our center between 1998 and 2010.
  
  
  RESULTS
  Sixteen patients underwent 17 CLKT at a median age of 5.3 years (range, 1.3-15.9 years). Median body weight at CLKT was 17.7 kg (range, 9.2-55 kg). Underlying diagnosis was primary hyperoxaluria type 1 in nine patients and autosomal recessive polycystic kidney disease in seven patients. Median time on PICU was 8.5 days (range, 3-68 days); however, patients with primary hyperoxaluria type 1 had a significantly longer stay (P=0.031). Median duration of ventilation was 1 day; however, five patients required ventilation for 25 to 52 days. Continuous veno-venous hemofiltration was applied in nine patients due to delayed kidney graft function, volume overload, or high plasma oxalate. Overall, the survival rate after CLKT was 100% and long-term outcome was very good at a mean follow-up of 3.6 years (range, 0.5-12.2 years). Waiting time, donor age, and donor-to-recipient weight ratio were found to be significant risk factors for an extended PICU stay (P=0.02, 0.0031, and 0.014, respectively).
  
  
  CONCLUSIONS
  Immediate postoperative course after CLKT may be challenging and complex. However, excellent results can be achieved, even in small children.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Egmont
authors.initials: E
authors.lastname: Harps
authors.forename: Florian
authors.initials: F
authors.lastname: Brinkert
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
authors.forename: Andrea
authors.initials: A
authors.lastname: Briem-Richter
authors.forename: Michael
authors.initials: M
authors.lastname: van Husen
authors.forename: Susanne
authors.initials: S
authors.lastname: Schmidtke
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.forename: Lutz
authors.initials: L
authors.lastname: Fischer
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D051799:Delayed Graft Function / Q000209:etiology / Q000628:therapy; D005858:Germany; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D007902:Length of Stay; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D011182:Postoperative Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome