Liver Transplant for Primary Hyperoxaluria Type 1: Results of Sequential, Combined Liver and Kidney, and Preemptive Liver Transplant

Horoub, Rafat; Shamsaeefar, Alireza; Dehghani, Masood; Nikoopour, Hamed; Entezari, Majid; Moradi, Ali; Kazemi, Kourosh; Eshraghian, Ahad; Nikeghbalian, Saman; Malek-Hosseini, Seyed Ali

doi:10.6002/ect.2019.0150

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Out of 34 liver transplantations, 30 were functioning at time of last follow-up (median 4 years, range 1-16 years). Liver graft failure was reported in two cases [30,48] and three patients died [30,60,61]. Kidney function stabilized in 25 cases following transplantation, and at least ten of them showed improved kidney function (range 20.0-43.8%, Table 2).…”

Section: Pre-emptive Liver Transplantationmentioning

confidence: 97%

“…Three studies of strong quality compared patient and kidney graft survival rates between CLKT and SLKT recipients [22,27,30]. None of the studies found a significant difference in patient or kidney graft survival when comparing CLKT to SLKT.…”

Section: Combined Liver-kidney Transplant Versus Sequential Liver-kidney Transplantmentioning

confidence: 99%

“…Of note, an unknown number of patients who were scheduled for SLKT but died after liver transplantation were not included in this registry study. Horoub et al studied a cohort with high mortality rates in both groups [30]. All patients received a liver and kidney transplant.…”

Section: Combined Liver-kidney Transplant Versus Sequential Liver-kidney Transplantmentioning

confidence: 99%

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Transplantation outcomes in patients with primary hyperoxaluria: a systematic review

et al. 2021

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Background Primary hyperoxaluria type 1 (PH1) is characterized by hepatic overproduction of oxalate and often results in kidney failure. Liver-kidney transplantation is recommended, either combined (CLKT) or sequentially performed (SLKT). The merits of SLKT and the place of an isolated kidney transplant (KT) in selected patients are unsettled. We systematically reviewed the literature focusing on patient and graft survival rates in relation to the chosen transplant strategy. Methods We searched MEDLINE and Embase using a broad search string, consisting of the terms ‘transplantation’ and ‘hyperoxaluria’. Studies reporting on at least four transplanted patients were selected for quality assessment and data extraction. Results We found 51 observational studies from 1975 to 2020, covering 756 CLKT, 405 KT and 89 SLKT, and 51 pre-emptive liver transplantations (PLT). Meta-analysis was impossible due to reported survival probabilities with varying follow-up. Two individual high-quality studies showed an evident kidney graft survival advantage for CLKT versus KT (87% vs. 14% at 15 years, p<0.05) with adjusted HR for graft failure of 0.14 (95% confidence interval: 0.05–0.41), while patient survival was similar. Three other high-quality studies reported 5-year kidney graft survival rates of 48–89% for CLKT and 14–45% for KT. PLT and SLKT yielded 1-year patient and graft survival rates up to 100% in small cohorts. Conclusions Our study suggests that CLKT leads to superior kidney graft survival compared to KT. However, evidence for merits of SLKT or for KT in pyridoxine-responsive patients was scarce, which warrants further studies, ideally using data from a large international registry.

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Section: Pre-emptive Liver Transplantationmentioning

confidence: 97%

Section: Combined Liver-kidney Transplant Versus Sequential Liver-kidney Transplantmentioning

confidence: 99%

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Transplantation outcomes in patients with primary hyperoxaluria: a systematic review

et al. 2021

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“…However, there is ongoing discussion on the merits of a two-step procedure, referred to as sequential liver-kidney transplantation (SLKT) [10 11]. To date, studies have not found significant differences in patient or graft survival between CLKT and SLKT in PH1 patients [12][13][14]. The choice between CLKT and SLKT is based on the patient's condition and local facilities [8] and the availability of a living donor [11].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Transplantation Outcomes in Patients With Primary Hyperoxaluria Type 1 Included in the European Hyperoxaluria Consortium (OxalEurope) Registry

Metry

Garrelfs

Peters‐Sengers

et al. 2022

Kidney International Reports

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“…Isolated kidney transplantation should not be considered, because it doesn’t solve the problem of deficiency of enzyme for glyoxylate metabolism [ 22 ]. For patients who have developed ESRD, combined liver and kidney transplant is an optimal modality of treatment [ 25 ]. Sequential transplant (transplant of liver and kidney at different time periods) may be proposed in individual ESRD patients.…”

Section: Discussionmentioning

confidence: 99%

Primary hyperoxaluria diagnosed after kidney transplantation: a case report and literature review

et al. 2021

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Background Primary hyperoxaluria (PH) is a rare inherited autosomal recessive disease caused by disturbed glyoxylate metabolism. The disease is characterized by calcium oxalate crystal deposition in various organs, especially in the kidney. Due to the lack of current understanding of PH, nearly all patients are only initially diagnosed with PH when recurrent lithiasis and progressive end-stage renal disease occur. Many cases are not diagnosed in patients until renal allograft insufficiency occurs after renal transplantation. This case report and literature review aim to emphasize the need for careful pre-transplant PH screening of patients with bilateral nephrocalcinosis or nephrolithiasis. Case presentation Renal allograft insufficiency was diagnosed as PH after kidney transplantation. Here, we detail the complete clinical course, including computed tomography images of the original kidney and renal graft, histopathological images of a biopsy of the transplanted kidney, the results of laboratory and molecular genetic tests, and the treatment. In addition, we reviewed the literature from 2000 to 2021 and analyzed 19 reported cases of PH diagnosed after kidney transplantation, and provide a summary of the characteristics, complications, treatment, and prognosis of these cases. Conclusions By reviewing and analyzing these cases, we concluded that patients with a history of nephrocalcinosis or nephrolithiasis in both kidneys need preoperative screening for PH and appropriate treatment before kidney transplantation. Delayed graft function caused by PH is easily misdiagnosed as acute rejection, and needle biopsy should be performed at an early stage.

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Liver Transplant for Primary Hyperoxaluria Type 1: Results of Sequential, Combined Liver and Kidney, and Preemptive Liver Transplant

Cited by 7 publications

References 28 publications

Transplantation outcomes in patients with primary hyperoxaluria: a systematic review

Transplantation outcomes in patients with primary hyperoxaluria: a systematic review

Long-Term Transplantation Outcomes in Patients With Primary Hyperoxaluria Type 1 Included in the European Hyperoxaluria Consortium (OxalEurope) Registry

Primary hyperoxaluria diagnosed after kidney transplantation: a case report and literature review

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