One hundred percent patient and kidney allograft survival with simultaneous liver and kidney transplantation in infants with primary hyperoxaluria: a single-center experience.
BACKGROUND
Combined liver-kidney transplantation is the definitive treatment for end-stage renal disease caused by primary hyperoxaluria type I (PH1). The infantile form is characterized by renal failure early in life, advanced systemic oxalosis, and a formidable mortality rate. Although others have reported on overall results of transplantation for PH1 covering a wide age spectrum, none has specifically addressed the high-risk infantile form of the disease.


METHODS
Six infants with PH1 underwent simultaneous liver-kidney transplantation at our center between May 1994 and August 1998. Diagnosis was made at 5.2+/-3.3 months of age, they were on dialysis for 11.8+/-2.3 months, and they underwent transplantation at 14.8+/-3.0 months of age when they weighed 10.6+/-1.7 kg.


RESULTS
At a mean follow-up of 6.4+/-1.7 years (range, 3.9-8.1 years), we report 100% patient and kidney allograft survival. There were no cases of acute tubular necrosis. Long-term kidney allograft function remained stable in all patients, with serum creatinine values of less than 1.1 mg/dL and a mean creatinine clearance of 99 mL/min/1.73 m2 at follow-up. Those who received combined hemodialysis and peritoneal dialysis pretransplant had lower posttransplant urinary oxalate values than those receiving peritoneal dialysis alone. There was improvement in growth and psychomotor and mental developmental scores after transplantation.


CONCLUSIONS
Combined liver-kidney transplantation for the infantile presentation of PH1 is associated with excellent outcome when the approach includes early diagnosis and early combined transplantation, aggressive pretransplant dialysis, and avoidance of posttransplant renal dysfunction.
Millan
Maria T
MT
Stanford University School of Medicine, Palo Alto, CA 94304, USA. mmillan@stanford.edu
Berquist
William E
WE
So
Sam K
SK
Sarwal
Minnie M
MM
Wayman
Karen I
KI
Cox
Kenneth L
KL
Filler
Guido
G
Salvatierra
Oscar
O
Esquivel
Carlos O
CO
D001824:Body Constitution; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology*; D006128:Growth / Q000502:physiology*; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000601:surgery*; D007223:Infant; D007239:Infections / Q000453:epidemiology; D016030:Kidney Transplantation / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D010070:Oxalates / Q000097:blood / Q000652:urine; D011183:Postoperative Complications / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D010070:Oxalates; D003404:Creatinine