Presentation of an acquired urea cycle disorder post liver transplantation.
The liver's role as the largest organ of metabolism and the unique and often critical function of liver-specific enzyme pathways imply a greater risk to the recipient of acquiring a donor metabolic disease with liver transplants versus other solid organ transplants. With clinical consequences rarely reported, the frequency of solid organ transplant transfer of metabolic disease is not known. Ornithine transcarbamylase deficiency (OTCD), although rare, is the most common of the urea cycle disorders (UCDs). Because of phenotypic heterogeneity, OTCD may go undiagnosed into adulthood. With over 5000 liver transplant procedures annually in the United States, the likelihood of unknowingly transmitting OTCD through liver transplantation is very low. We describe the clinical course of a liver transplant recipient presenting with acute hyperammonemia and encephalopathy after receiving a liver graft form a donor with unrecognized OTCD.
Ghabril
Marwan
M
Hepatology and Gastroenterology, Mayo Clinic, Jacksonville, FL 32216, USA.
Nguyen
Justin
J
Kramer
David
D
Genco
Trina
T
Mai
Martin
M
Rosser
Barry G
BG
D017809:Fatal Outcome; D005260:Female; D006501:Hepatic Encephalopathy / Q000201:enzymology / Q000209:etiology; D006801:Humans; D022124:Hyperammonemia / Q000201:enzymology / Q000209:etiology; D008099:Liver / Q000201:enzymology* / Q000601:surgery; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D020163:Ornithine Carbamoyltransferase Deficiency Disease / Q000150:complications / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology / Q000628:therapy; D014019:Tissue Donors; D016896:Treatment Outcome; D014508:Urea / Q000378:metabolism*
D014508:Urea