Transplantation in adults with primary hyperoxaluria: single unit experience and treatment algorithm.
BACKGROUND
Kidney transplantation alone in Primary Hyperoxaluria is associated with a high rate of recurrence and in many cases early graft loss. Liver transplantation offers the possibility of correcting the metabolic defect.


METHODS
A retrospective review of five cases of Primary Hyperoxaluria managed at a major transplant unit was performed.


RESULTS
The 5 patients had a mean age of 32.2 years (range 28-40) at time of first transplantation. 3 patients had kidney only transplants (one live donor, 2 deceased donor) and 2 had segmental liver followed by delayed kidney transplantation. All 3 kidney alone failed and one is now awaiting a live donor transplant, one underwent kidney alone retransplantation (failed 5 years later) and one had a combined deceased donor liver and kidney transplantation (remains well at 4 years). The 2 segmental liver sequential kidney transplant recipients remain well at 1 year and 3 years.


CONCLUSIONS
Combined liver-kidney transplantation may be a better choice as the primary transplant procedure. The indication and timing for pre-emptive liver or liver followed by delayed kidney transplantation remains a matter of debate.
Transplant Unit, Manchester Royal Infirmary, Oxford Road, Manchester, U.K. drdeepmalde@yahoo.com
Deep J
DJ
Malde
Ravi
R
Pararajasingam
Afshin
A
Tavakoli
Babatunde
B
Campbell
Hany
H
Riad
Neil
N
Parrot
K Rajendra
KR
Prasad
Titus
T
Augustine
D000328:Adult; D000465:Algorithms; D005260:Female; D006801:Humans; D006960:Hyperoxaluria, Primary / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult