Recent data on results of isolated kidney or combined kidney/liver transplantation in the U.S.A. for primary hyperoxaluria.
Renal transplant for primary hyperoxaluria (PH) has been problematic. K/L-Tx is used almost exclusively in Europe. In USRDS data 235 patients had PH diagnosed at ESRD, another 47 found later. Since 1994, there were 176, since our modern management protocol, 96 under age 55. Of 82 non-K/L-Tx, 40 of 49 were alive after K-Tx, 14 of 33 without Tx. By lifetable analysis, survival was better for K-Tx (85% at 5 yrs, 75% at 10 yrs) than for non-Tx patients (40% at 5 yrs, 75% at 10 yrs) (P < .001). First Tx graft lifetable survival was 70% for LRD, 50% for CAD Tx at 3 yrs, both 40-45% at 5 years (N.S.). Twenty-eight K/L-Tx PH patients from the UNOS database had projected survival 50% at 5 yrs. Overall, transplant is better for patient survival than no transplant. While curative, K/L-Tx still has considerable risk in the U.S., but could follow failed K-Tx. Confirmation of PH and ruling out B6 sensitivity must precede K/L-Tx to justify its risk. Post Tx management for K/L-Tx must follow protocols developed to prevent oxalate recurrence for K-Tx.
Scheinman
J I
JI
Medical College of Virginia, Richmond 23298-0498, USA.
D016208:Databases, Factual; D006085:Graft Survival; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D015993:Life Tables; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology