Combined Liver–Kidney Transplantation in Pediatric Patients From Colombia: A Case Series

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ABSTRACT Background Pediatric combined liver–kidney transplantation is uncommon, and evidence from Latin America is scarce. Methods We report a single‐center case series of four pediatric recipients who underwent combined liver–kidney transplantation at a tertiary Latin‐American center. We summarize primary indications, perioperative course, early complications, and graft function at follow‐up. Results Underlying diseases were primary hyperoxaluria type I ( n = 1), nephronophthisis type 3 ( n = 2), and hepatorenal fibropolycystic disease/autosomal recessive polycystic kidney disease ( n = 1). Early complications included bacterial and viral infections, bleeding, and acute tubular necrosis. Three biopsy‐proven acute rejection episodes occurred (one moderate–severe hepatic and two renal, including one late T‐cell–mediated episode); all responded to treatment. At last follow‐up, all four patients were alive with functioning liver and kidney grafts. In three cases with long‐term follow‐up, the estimated glomerular filtration rate was 72, 64, and 48 mL/min/1.73 m 2 with normal liver profiles; in one case with shorter institutional follow‐up, the estimated glomerular filtration rate was 74 mL/min/1.73 m 2 with a transient liver profile abnormality. Conclusions This first pediatric series from Latin America suggests that combined liver–kidney transplantation is feasible and can achieve favorable long‐term patient and graft survival when candidates are appropriately selected and infectious and rejection complications are managed in a protocolized manner.

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