Blog entry by mohammad katout
Ever wondered what is renal graft outcome (patient and renal graft survival, incidence of acute rejection and long-term renal allograft function) in combined liver & kidney transplantation (CLKT) as compared to isolated kideny transplantation (KT)?
Read the below to find out what the nephrology and hepatology teams at Birmingham Children’s Hospital found when they carried out this case–control study.
- The kidney graft survival for CLKT patients (primary diagnosis fibro-polycystic liver & kidney disease- FPLKD in 65% of them) was 87.4, 82, and 82 % at 1, 5, and 10 years .
- Allograft survival rates in KT recipients were 97.2, 93, and 93 % at 1, 5, and 10 year follow-up and this was not significantly different (p > 0.05) from CLKT recipients. That being said, higher initial rate of graft loss was noted in CLKT patients given the higher morbidity and mortality associated with the operation.
- CLKT recipients had fewer acute rejection episodes and better long-term renal graft survival when compared to isolated KT. Only 5 % of CLKT recipients had acute rejection compared to 12.5 % of KT recipients. If this could be attributable to a hepatic immunomodulatory effect leading to a degree of tolerance remains unclear.
- Plasma creatinine at 1 and 5 years following transplantation was significantly lower in children undergoing CLKT for FPLKD compared to those with Primary hyperoxaluria- PH and a significantly higher 1-year e-GFR in patients with FPLKD than in those who had PH. This is presumably due to the risk of oxalate deposition in the transplanted kidney given oxalate mobilization from bones and tissues post-transplantation.
- The decline in mean eGFR between 5 and 10 years from transplantation was greater (−19.14 ml/min/1.73 m2 in 5 years) in KT recipients compared to CLKT (−7.6 ml/min/1.73 m2 in 5 years) (p = 0.043).
- Could the noticed trend in favor of better renal graft function in CLKT recipients in comparison to KT recipients in this study be significantly documented in future studies? This remains remains to be answered.
READ THE ORIGINAL ARTICLE AND COMMENT!
Ranawaka R, Lloyd C, McKiernan PJ, Hulton SA, Sharif K, Milford DV. Combined liver and kidney transplantation in children: analysis of renal graft outcome. Pediatr Nephrol 2016;31(9):1539-43