Combined liver and kidney transplantation in children.

[primary hyperoxaluria type 1]

Simultaneous combined liver -kidney transplantation (CLKT ) is a rare operation in pediatric patients so that annually only 10 -30 operations are performed worldwide . The main indications for CLKT are primary hyperoxaluria type 1 and autosomal recessive polycystic kidney disease . In addition , CLKT is indicated in individual patients with metabolic or cirrhotic liver diseases and end-stage kidney disease . The surgery and immediate post-operative management of CLKT remain challenging in infants and small children . The patients should be operated on before they become severely ill or develop major systemic manifestations of their metabolic disorder . The liver allograft is immunologically protective of the kidney graft in simultaneous CLKT , often resulting in well-preserved kidney function . The long -term outcome after CLKT is nowadays comparable to that of isolated liver and kidney transplantations .