Immediate Postoperative Intensive Care Treatment of Pediatric Combined Liver-Kidney Transplantation: Outcome and Prognostic Factors.
Harps, Egmont 1; Brinkert, Florian 2,6; Ganschow, Rainer 3; Briem-Richter, Andrea 3; van Husen, Michael 4; Schmidtke, Susanne 1; Herden, Uta 5; Nashan, Bjorn 5; Fischer, Lutz 5; Kemper, Markus J. 4
91(10):1127-1131, May 27, 2011.
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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.
(C) 2011 Lippincott Williams & Wilkins, Inc.