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 .

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Diseases presenting "small children" symptom

coats disease

hydrocephalus with stenosis of the aqueduct of sylvius

primary hyperoxaluria type 1

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