Sequential liver and kidney transplantation from a single living donor in two young adults with primary hyperoxaluria type 1

Abstract

Using living donor organs for sequential liver and kidney transplantation (SeqLKT) in patients with primary hyperoxaluria type 1 (PH1) has emerged as a viable approach. Taking both organs from a single donor, however, is rare. There are 8 reported cases of SeqLKT in the literature, and in all but 1 case, children were the recipients. We present our experience with SeqLKT in 2 young adults with PH1. In the first case, with an interval between procedures of 4.5 months, SeqLKT was performed with a right liver lobe from a 47-year-old father for his 19-year-old son with PH1 who was on dialysis for 2 years before transplantation. Both the donor and the recipient had an uneventful recovery, although there was re-exploration for the control of bleeding in the recipient after liver transplantation. Thirty-three months after transplantation, the patient had normal liver and renal function. In the second case, with an interval between procedures of 22 days, SeqLKT was performed with organs from a 45-year-old father for his 19-year-old daughter with PH1 who was on dialysis for 8 months. The recipient procedures, including right liver lobe transplantation and kidney transplantation, were uneventful. The donor underwent percutaneous drainage of a subphrenic collection and subsequently fully recovered. Eighteen months after transplantation, the recipient's liver and renal allograft function was normal. In conclusion, because of the severe organ shortage, living related SeqLKT using the same donor should be carefully considered for young adults with PH1.

The experience of combined and sequential liver and kidney transplantation from a single living donor in patients with primary hyperoxaluria type 1

“…For SLKT cases, most often one of the organs is procured from a living donor and the other from a deceased donor . Reports about CLKT and SLKT from a single living donor are limited from countries where a shortage of deceased donors remains a problem . In this single‐center series, it is illustrated that CLKT and SLKT are feasible and safe from a single living donor, even in pediatric patients.…”

“…However, there is no consensus for the best interval between liver and kidney transplantations. A minimum of 22 days and a maximum of 10 months for the interval have been reported . All of the SLKT patients in this study were treated with an intensified HD protocol after LT for four months in accordance with the literature.…”

“…Even though most publications about PH1 patients who have undergone transplantation have reported on deceased donors, studies reporting on living donors with good outcomes have increased in recent years . Most of the CLKT reports have been on cases from single deceased donors.…”

“…Most studies report on CLKT and SLKT in patients with PH1 from deceased donors. There are a few reports in which both organs were taken from a single living donor from countries where a shortage of organ donation remains a problem, as in Turkey . The aim of this report was to describe our experience with CLKT and SLKT from single living donors in patients with PH1.…”

Simultaneous liver kidney transplant

“…In countries with limited deceased donors both the organs can come from the same living donor donor, living related sequential liver kidney transplant. 40 …”