Improved Outcomes of Combined Liver and Kidney Transplants in Small Children (<15 kg)

Background. Combined liver and kidney transplantation (CLKT) is a surgical challenge in small children because of technical aspects, lack of pediatric donors, and restrictions related to the size of the abdominal cavity. We report outcomes after CLKT in this challenging group of smaller children. Method. A review of prospective data on all children undergoing CLKT at the Birmingham Children's Hospital between 1994 and 2008 was performed. An analysis of perioperative data, complications, and survival in children less than 15 kg was carried out, with figures expressed as median (range) and compared with that of children more than 15 kg. Results. A total of 23 children underwent CLKT (14 male [61%] and age 8.6 [1.6-16.7] years), of which 8 (35%) were less than or equal to 15 kg, median age 2.2 (1.6-5.4) years, weight 11.6 (9.1-14.9) kg, and height 76 (66-95) cm, followed up for a median 26 (12-126) months. Donor details included age 13 (3-40) years, weight 60 (15-78) kg, and height 156 (83-168) cm. The median donor-to-recipient weight ratio was 4.8 compared with 1.7 for larger children. The median waiting time was 291 (48-523) compared with 150 (6-455) days for children more than 15 kg. Four of eight (50%) children received preoperative renal support, when compared with 10 of 16 (62%) children more than 15 kg. The intensive care unit and inpatient stay was 2 (2-22) days and 25 (19-93) days, respectively. Mortality was seen in one of eight because of sepsis and multiorgan failure. When compared with children more than 15 kg, survival figures at I and 2 years were 87% versus 93% and 78%, respectively. Conclusions. CLKT in small children results in comparable outcomes despite challenges related to donor-recipient size mismatch and longer waiting times. Consequently, body size/stature should not be a limiting factor for multiorgan transplantation.