Hellenkemper Jessica V, Grabhorn Enke, Brinkert Florian, Lenhartz Henning, Herrmann Jochen, Fischer Lutz, Helmke Knut, Herden Uta
Department of Transplant Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Pediatric Gastroenterology and Hepatology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Clin Transplant. 2019 Oct;33(10):e13687. doi: 10.1111/ctr.13687. Epub 2019 Oct 9.
Combined liver-kidney transplantation (CLKT) in children is still a rarely performed procedure. Our aim was to analyze the effect of the simultaneous transplantation of the kidney in pediatric CLKT on the liver graft flow velocity, and vascular complications compared to singular liver transplantation (LTX) in children.
All pediatric CLKT performed at our institution from 1998 to 2016 were matched with singular LTX and retrospectively analyzed.
Overall 30 CLKT were performed in 28 children (median age 8 years, range 1-16) and matched with 30 children undergoing singular LTX (median age 7.9 years, range 1-16). No significant differences were found concerning the systolic peak flow velocity of the hepatic artery (HA) or the resistance index (RI). Vascular complications of the hepatic vessels occurred in 16.7% (CLKT) and 6.7% (LTX). The 1-/5- and 10-year patient survival was 93.3%/93.3% and 93.3% (CLKT) and 100%/100% and 92.9% (LTX). 1-/5-and 10-year liver graft survival was 76.7%/73.2% and 73.2% (CLKT) and 84.4%/75.9% and 69.6% (LTX).
The simultaneous transplantation of the kidney in CLKT had no negative impact on hepatic flow velocity or vascular complications. Frequent Doppler ultrasound examinations, accurate volume management, and avoidance of abdominal pressure might be an explanation for the results and an excellent graft- and patient survival.
儿童肝肾联合移植（CLKT）仍是一种较少实施的手术。我们的目的是分析小儿CLKT中同时进行肾移植对肝移植血流速度的影响，以及与儿童单纯肝移植（LTX）相比的血管并发症情况。
对1998年至2016年在本机构进行的所有小儿CLKT与单纯LTX进行匹配，并进行回顾性分析。
共对28名儿童（中位年龄8岁，范围1 - 16岁）实施了30例CLKT，并与30例接受单纯LTX的儿童（中位年龄7.9岁，范围1 - 16岁）进行匹配。肝动脉（HA）的收缩期峰值流速或阻力指数（RI）未发现显著差异。肝血管的血管并发症在CLKT组发生率为16.7%，在LTX组为6.7%。1年/5年和10年的患者生存率在CLKT组分别为93.3%/93.3%和93.3%，在LTX组分别为100%/100%和92.9%。1年/5年和10年的肝移植生存率在CLKT组分别为76.7%/73.2%和73.2%，在LTX组分别为84.4%/75.9%和69.6%。
CLKT中同时进行肾移植对肝血流速度或血管并发症没有负面影响。频繁的多普勒超声检查、精确的容量管理以及避免腹压升高可能是取得这些结果以及获得良好的移植物和患者生存率的原因。
