title: Pediatric combined liver-kidney transplantation: a single-center experience of 18 cases.
abstract: Experience in combined liver-kidney transplantation (CLKT) in children is limited.
  
  
  
  We conducted a retrospective study of all pediatric CLKTs performed at our medical institution between 1992 and 2013.
  
  
  
  We identified 18 pediatric patients (9 girls) who had undergone CLKT at our institution during the study period. The median age [range] and body weight [range] of this patient group was 3.6 [1.0-18.6] years and 13 [10-40] kg, respectively; 11 patients weighed <15 kg at the time of CLKT. Indications for CLKT were primary hyperoxaluria (PH1; n = 14), association of hepatic fibrosis and end-stage renal disease (n = 3) and methylmalonic acidemia (n = 1). In the early postoperative period, eight patients required dialysis. Median stay in the pediatric intensive care unit was 10 [6-29] days. One patient died from cardiovascular disease 10 years after CLKT. There were no liver graft losses despite six acute liver rejection episodes, whereas four kidney grafts were lost. At last follow-up (6 [0.5-21] years) for patients with a functioning renal graft, the glomerular filtration rate was 71 [26-146] mL/min/1.73 m(2). In PH1 patients, urine oxalate normalized in six patients within 3 years after CLKT, but three patients still presented with elevated oxaluria at 1, 2 and 3 years after CLKT.
  
  
  
  Pediatric CLKT provides encouraging results in the long term, even in the youngest patients.
authors.affiliation: Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. remi.duclauxloras@gmail.com.|Université Claude-Bernard Lyon 1, Lyon, France. remi.duclauxloras@gmail.com.|Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France. remi.duclauxloras@gmail.com.
authors.forename: Rémi
authors.initials: R
authors.lastname: Duclaux-Loras
authors.affiliation: Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.|Université Claude-Bernard Lyon 1, Lyon, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.affiliation: Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Berthiller
authors.affiliation: Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rivet
authors.affiliation: Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Demède
authors.affiliation: Université Claude-Bernard Lyon 1, Lyon, France.|Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Javouhey
authors.affiliation: Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Dubois
authors.affiliation: Université Claude-Bernard Lyon 1, Lyon, France.|Anatomie Pathologique, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Dijoud
authors.affiliation: Université Claude-Bernard Lyon 1, Lyon, France.|Hépatologie Gastro-Entérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron cedex, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Lachaux
authors.affiliation: Université Claude-Bernard Lyon 1, Lyon, France.|Chirurgie Urologique et chirurgie de la transplantation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.affiliation: Université Claude-Bernard Lyon 1, Lyon, France.|Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.affiliation: Centre de Référence des Maladies Rénales Rares Néphrogones, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.|Université Claude-Bernard Lyon 1, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Cochat
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008099:Liver; D016031:Liver Transplantation; D008297:Male; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Boichis syndrome; Child; Combined liver–kidney transplantation; Methylmalonic acidemia; Primary hyperoxaluria type 1