Severe course of primary hyperoxaluria and renal failure after domino hepatic transplantation.
We report herein a domino orthotopic liver transplantation (LT), from a 38-year-old woman undergoing liver-kidney transplantation (LKT) for primary hyperoxaluria type I (PH1) to a recipient with cirrhosis and hepatocellular carcinoma. Delayed onset of PH1 and renal failure and 10% residual alanine-glyoxylate aminotransferase (AGT) activity in domino liver justified its use for domino procedure. The clinical course after LKT was similar to that described in other series, including ours. Renal function started promptly and maintained despite sustained hyperoxaluria from dissolution of oxalotic deposits. Conversely, the domino recipient manifested severe hyperoxaluria and developed nephrolithiasis and renal insufficiency with rapid progression over 2 months. A new LT resulted in slow decrease of oxaluria and improvement of renal function. Therefore, PH1 behaved quite differently in these two patients, leading us to conclude that domino LT using livers from PH1 patients should be considered very carefully, only as a bridge to definitive LT in recipients with critical clinical conditions.
Franchello
Alessandro
A
Centro Trapianti di Fegato, Torino, Italy.
Paraluppi
Gianluca
G
Romagnoli
Renato
R
Petrarulo
Michele
M
Vitale
Corrado
C
Pacitti
Alfonso
A
Amoroso
Antonio
A
Marangella
Martino
M
Salizzoni
Mauro
M
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005355:Fibrosis / Q000628:therapy; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000175:diagnosis* / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000209:etiology*; D013997:Time Factors; D020858:Tissue and Organ Harvesting / Q000379:methods; D009927:Tissue and Organ Procurement / Q000379:methods; D000637:Transaminases / Q000378:metabolism
D000637:Transaminases; C019635:Alanine-glyoxylate transaminase