title: Combined paediatric liver-kidney transplantation: analysis of our experience and literature review.
abstract: BACKGROUND
  Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject.
  
  
  METHODS
  Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted.
  
  
  RESULTS
  Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months.
  
  
  CONCLUSIONS
  Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.
authors.affiliation: Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa. dr.strobele@gmail.com.
authors.forename: Bernd
authors.initials: B
authors.lastname: Strobele
authors.forename: Jerome
authors.initials: J
authors.lastname: Loveland
authors.forename: Russell
authors.initials: R
authors.lastname: Britz
authors.forename: Errol
authors.initials: E
authors.lastname: Gottlich
authors.forename: Anna
authors.initials: A
authors.lastname: Welthagen
authors.forename: Jean
authors.initials: J
authors.lastname: Botha
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017242:Complement Factor H / Q000172:deficiency; D058625:End Stage Liver Disease / Q000209:etiology / Q000601:surgery; D005260:Female; D000081208:Hereditary Complement Deficiency Diseases; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D017044:Polycystic Kidney, Autosomal Recessive / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D013019:South Africa; D015996:Survival Rate; D016896:Treatment Outcome; D015432:Glomerulonephritis, Membranoproliferative
chemical_list: D017242:Complement Factor H