Pediatric combined liver-kidney transplantation: a 2015 update.
OBJECTIVE
The experience of combined liver-kidney transplantation (CLKT) is limited in pediatric populations. This strategy is, however, required in specific diseases such as metabolic diseases (namely primary hyperoxaluria type one and methylmalonic acidemia), autosomal recessive polycystic kidney disease, miscellaneous ciliopathies and atypical hemolytic uremic syndrome.


RESULTS
Different series and registry studies have confirmed the feasibility of pediatric CLKT with encouraging results in the long term, even in the youngest and smallest patients, provided that highly trained multidisciplinary teams are involved in this global management. As such, the long-term outcomes after CLKT are currently comparable to that of isolated liver or kidney transplantations, even though the immediate postoperative period remains challenging.


CONCLUSIONS
Some questions remain nevertheless unanswered, such as the respective place of combined versus sequential liver-kidney transplantation, especially in primary hyperoxaluria and autosomal recessive polycystic kidney disease. The aim of this review was therefore to provide a 2015 update on pediatric CLKT. In the future, international collaborative studies and registries may help to improve our knowledge of this rare and still highly challenging technique.
aCentre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron Cedex bUniversité Lyon 1, Faculté de Médecine Lyon Est, Lyon, France cDepartment of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium dService d'Hépato-Gastro-Entérologie et de Nutrition Pédiatrique eChirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
Justine
J
Bacchetta
Djalila
D
Mekahli
Christine
C
Rivet
Delphine
D
Demède
Anne-Laure
AL
Leclerc
D002648:Child; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000601:surgery; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods; D008107:Liver Diseases / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D012042:Registries