Department of Pediatrics, Pediatric Intensive Care Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Transplantation. 2011 May 27;91(10):1127-31. doi: 10.1097/TP.0b013e318216c1bb.
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.
虽然此时期对患儿的存活和长期预后至关重要，但联合肝-肾移植（CLKT）后即刻转入儿科重症监护病房（PICU）接受治疗的相关研究却十分有限。
我们对 1998 年至 2010 年期间在本中心接受的所有小儿 CLKT 进行了回顾性分析。
16 例患儿共接受了 17 次 CLKT，中位年龄为 5.3 岁（范围，1.3-15.9 岁）。CLKT 时的中位体重为 17.7kg（范围，9.2-55kg）。9 例患儿的基础诊断为 1 型原发性高草酸尿症，7 例患儿的基础诊断为常染色体隐性多囊肾病。PICU 中位停留时间为 8.5 天（范围，3-68 天）；但 1 型原发性高草酸尿症患儿的停留时间明显更长（P=0.031）。中位通气时间为 1 天；但有 5 例患儿需要通气 25-52 天。9 例患儿因移植肾功能延迟、容量超负荷或血浆草酸盐水平过高而应用连续静脉-静脉血液滤过。总的来说，CLKT 后的生存率为 100%，在中位随访 3.6 年（范围，0.5-12.2 年）后，长期预后非常好。研究发现，等待时间、供体年龄和供体与受体体重比是 PICU 停留时间延长的显著危险因素（P=0.02、0.0031 和 0.014）。
CLKT 后即刻的术后过程可能具有挑战性且复杂，但即使是在小患儿中，也可以获得良好的效果。
