Early renal failure after domino liver transplantation using organs from donors with primary hyperoxaluria type 1.
BACKGROUND
Organ shortage is responsible for high mortality rates of patients awaiting liver transplantation (LT). Domino transplantation has had reported success in patients with metabolic disorders. Primary hyperoxaluria type 1 (PH1) is a rare metabolic disorder. There are a few case reports that suggest that PH1 livers originating from donors that have undergone combined liver-kidney transplantation can be successfully used for domino transplantation.


METHODS
In the last decade, five patients received a domino liver transplant from patients with PH1 in the EUROTRANSPLANT region. In this study, we report the clinical course and outcome of these five patients who were received a domino graft transplant.


RESULTS
All patients, with the exception of one, suffered from multifocal hepatocellular carcinoma and underwent domino LT from patients undergoing combined liver-kidney transplantation for PH1. Within the first 4 weeks, all the domino recipients developed dialysis-dependent kidney failure despite good liver function. Four of the five patients died. The only survivor underwent retransplantation due to hepatic artery thrombosis. Twenty months after transplantation, this patient is doing well and has had no recurrence of hepatocellular carcinoma.


CONCLUSIONS
Domino LT using donors with PH1 results in early renal failure and cannot be recommended for transplantation unless preventive strategies have been identified.
Saner
Fuat H
FH
Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany. fuat.saner@uni-due.de
Treckmann
Juergen
J
Pratschke
Johann
J
Arbogast
Helmut
H
Rahmel
Axel
A
Vester
Udo
U
Paul
Andreas
A
D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016887:Cardiopulmonary Resuscitation; D003956:Dialysis; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000145:classification / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D010070:Oxalates / Q000097:blood / Q000652:urine; D011655:Pulmonary Embolism / Q000473:pathology; D012086:Reoperation; D014019:Tissue Donors / Q000706:statistics & numerical data*; D017211:Treatment Failure; D016896:Treatment Outcome
D010070:Oxalates