Fulltext

Early renal failure after domino hepatic transplantation using the liver from a compound heterozygous patient with primary hyperoxaluria

Farese, Stefan ; Trost, Nicolas ; Candinas, Daniel ; Huynh-Do, Uyen

In: Nephrology Dialysis Transplantation, 2005, vol. 20, no. 11, p. 2557-2560

Ajouter à la liste personnelle
    Titre
    • Early renal failure after domino hepatic transplantation using the liver from a compound heterozygous patient with primary hyperoxaluria
    Auteur
    • Farese, Stefan. Division of Nephrology and Hypertension, and
    • Trost, Nicolas. Division of Nephrology and Hypertension, and
    • Candinas, Daniel. Department of Visceral and Transplantation Surgery, University of Bern Medical School, Inselspital, Bern, Switzerland
    • Huynh-Do, Uyen. Division of Nephrology and Hypertension, and
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Nephrology Dialysis Transplantation, 2005, vol. 20, no. 11, p. 2557-2560. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:297043
    Summary
    Background. To cover the shortage of cadaveric organs, new approaches to expand the donor pool are needed. Here we report on a case of domino liver transplantation (DLT) using an organ harvested from a compound heterozygous patient with primary hyperoxaluria (PHO), who underwent combined liver and kidney transplantation. The DLT recipient developed early renal failure with oxaluria. The time to the progression to oxalosis with renal failure in such situations is unknown, but, based on animal data, we hypothesize that calcineurin inhibitors may play a detrimental role. Methods. A cadaveric liver and kidney transplantation was performed in a 52-year-old male with PHO. His liver was used for a 64-year-old patient with a non-resectable, but limited cholangiocarcinoma. Results. While the course of the PHO donor was uneventful, in the DLT recipient early post-operative, dialysis-dependent renal failure with hyperoxaluria developed. Histology of a kidney biopsy revealed massive calcium oxalate crystal deposition as the leading aetiological cause. Conclusions. DLT using PHO organs for marginal recipients represents a possible therapeutic approach regarding graft function of the liver. However, it may negatively alter the renal outcome of the recipient in an unpredictable manner, especially with concomitant use of cyclosporin. Therefore, we suggest that, although DLT should be promoted, PHO organs are better excluded from such procedures