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Immediate postoperative intensive care treatment of pediatric combined liver-kidney transplantation: outcome and prognostic factors.
[primary hyperoxaluria type 1]
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
.
We
retrospectively
analyzed
all
pediatric
CLKT
performed
in
our
center
between
1998
and
2010
.
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
)
.
Immediate
postoperative
course
after
CLKT
may
be
challenging
and
complex
.
However
,
excellent
results
can
be
achieved
,
even
in
small
children
.
Diseases
Validation
Diseases presenting
"long-term outcome"
symptom
aniridia
cholangiocarcinoma
classical phenylketonuria
cystinuria
erythropoietic protoporphyria
esophageal squamous cell carcinoma
fabry disease
hirschsprung disease
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kabuki syndrome
krabbe disease
oligodontia
papillon-lefèvre syndrome
primary hyperoxaluria type 1
trochlear dysplasia
von hippel-lindau disease
waldenström macroglobulinemia
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