Introduction

Simultaneous liver-kidney (SLK) transplant is a rare procedure indicated for several conditions, including autosomal recessive polycystic kidney disease (ARPKD), genetic and metabolic diseases. Other indications include children who previously received isolated liver (IL) or kidney (IK) transplants that failed and have associated kidney or liver failure. We examine a 25-year single-center experience with SLK.

Methods

A retrospective analysis of SLK recipients at our institution from 2000 to 2025 was performed. We report a descriptive analysis of this cohort, including graft and patient survival.

Results

Twelve of 204 transplant patients (5.8%) received SLK transplant in the study period. Recipient ages ranged from 5 months to 21 years, with a median age of 4.5 years. Indications included ARPKD (4), genetic (2), and metabolic disease (2). Four additional patients had failed IL or IK transplants. 1- and 5-year patient and graft survivals of the entire recipient population were 92% and 83%, respectively. All 4 who received SLK after failed isolated organ transplant were alive at 5 years with functioning grafts. 

Conclusion

SLK transplants are rare procedures in children.  As a group, graft and patient survival are lower than that reported for IL or IK transplants.  However, in the small group of children receiving SLK transplants for failed IL or IK transplant, patient and graft survival was excellent. Future multicenter studies may provide further insights into the outcomes and management for this rare population of pediatric transplant recipients.