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Combined liver kidney transplantation for primary hyperoxaluria type 1: Will there still be a future? Current transplantation strategies and monocentric experience
Author(s) -
Tandoi Francesco,
Cussa Davide,
Peruzzi Licia,
Catalano Silvia,
Camilla Roberta,
Mandrile Giorgia,
Calvo Pier Luigi,
Pi Michele,
Dell’Olio Dominic,
Salizzoni Mauro,
Amoroso Antonio,
Romagnoli Renato
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.14003
Subject(s) - primary hyperoxaluria , medicine , kidney , transplantation , kidney transplantation , liver transplantation , kidney disease , hemodialysis , surgery , urology , gastroenterology
Combined liver–kidney transplantation is a therapeutic option for children affected by type 1 primary hyperoxaluria. Persistently high plasma oxalate levels may lead to kidney graft failure. It is debated whether pre‐emptive liver transplantation, followed by kidney transplantation, might be a better strategy to reduce kidney graft loss. Our experience of 6 pediatric combined liver–kidney transplants for primary hyperoxaluria type 1 in pediatric recipients was retrospectively analyzed. Plasma oxalate levels were monitored before and after transplantation. All the recipients were on hemodialysis at transplantation. Median [IQR] recipient's age at transplantation was 11 [1–14] years; in all cases, a compatible graft from a pediatric brain‐dead donor aged 8 [2–16] years was used. In a median follow‐up of 7 [2–19] years after combined liver–kidney transplantation, no child died and no liver graft failure was observed; three kidney grafts were lost, due to chronic rejection, primary non‐function, and early renal oxalate accumulation. Liver and kidney graft survival remained stable at 1, 3, and 5 years, at 100% and 85%, respectively. Kidney graft loss was the major complication in our series. Risk is higher with very young, low‐weight donors. The impact of treatment with glyoxalate pathway enzyme inhibitors treatment in children with advanced disease as well as of donor kidney preservation by ex vivo machine perfusion needs to be evaluated. At present, a case‐by‐case discussion is needed to establish an optimal treatment strategy.