Jalanko Hannu, Pakarinen Mikko
Department of Pediatric Nephrology and Transplantation, Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Stenbackinkatu 11, 00290, Helsinki, Finland,
Pediatr Nephrol. 2014 May;29(5):805-14; quiz 812. doi: 10.1007/s00467-013-2487-7. Epub 2013 May 4.
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.
肝肾联合移植（CLKT）在儿科患者中是一种罕见的手术，因此全球每年仅进行10 - 30例手术。CLKT的主要适应症是1型原发性高草酸尿症和常染色体隐性多囊肾病。此外，个别患有代谢性或肝硬化性肝病以及终末期肾病的患者也适合进行CLKT。对于婴幼儿而言，CLKT的手术及术后即刻管理仍然具有挑战性。患者应在病情严重恶化或出现代谢紊乱的主要全身表现之前接受手术。在同期CLKT中，肝脏移植物对肾脏移植物具有免疫保护作用，常常能使肾功能得到良好维持。如今，CLKT后的长期预后与单独的肝移植和肾移植相当。
