Combined split liver and kidney transplantation in a three-year-old child with primary hyperoxaluria type 1 and complete thrombosis of the inferior vena cava

Zahida Khan, Marco Sciveres, Paola Salis, Marida Minervini, Giuseppe Maggione, Davide Cintorino, Silvia Riva, Bruno Gridelli, Francesco Emma, Marco Spada

Research output: Contribution to journalArticle

Abstract

PH1 is an inborn error of the metabolism in which a functional deficiency of the liver-specific peroxisomal enzyme, AGT, causes hyperoxaluria and hyperglycolic aciduria. Infantile PH1 is the most aggressive form of this disease, leading to early nephrocalcinosis, systemic oxalosis, and end-stage renal failure. Infantile PH1 is rapidly fatal in children unless timely liver-kidney transplantation is performed to correct both the hepatic enzyme defect and the renal end-organ damage. The surgical procedure can be further complicated in infants and young children, who are at higher risk for vascular anomalies, such as IVC thrombosis. Although recently a limited number of children with IVC thrombosis have underwent successful kidney transplantation, successful multi-organ transplantation in a child with complete IVC thrombosis is quite rare. We report here the interesting and technically difficult case of a three-yr-old girl with a complete thrombosis of the IVC, who was the recipient of combined split liver and kidney transplantation for infantile PH1. Although initial delayed renal graft function with mild-to-moderate acute rejection was observed, the patient rapidly regained renal function after steroid boluses, and was soon hemodialysis-independent, with good diuresis. Serum and plasma oxalate levels progressively decreased; although, to date they are still above normal. Hepatic and renal function indices were at, or approaching, normal values when the patient was discharged 15-wk post-transplant, and the patient continues to do well, with close and frequent follow-up. This is the first report of a successful double-organ transplant in a pediatric patient presenting with infantile PH1 complicated by complete IVC thrombosis.

Original languageEnglish
JournalPediatric Transplantation
Volume15
Issue number4
DOIs
Publication statusPublished - Jun 2011

Fingerprint

Inferior Vena Cava
Liver Transplantation
Kidney Transplantation
Thrombosis
Hyperoxaluria
Kidney
Liver
Nephrocalcinosis
Delayed Graft Function
Transplants
Inborn Errors Metabolism
Oxalates
Diuresis
Organ Transplantation
Enzymes
Chronic Kidney Failure
Blood Vessels
Renal Dialysis
Reference Values
Steroids

Keywords

  • children
  • combined split liver-kidney transplant
  • inferior vena cava thrombosis
  • oxalosis
  • primary hyperoxaluria

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Combined split liver and kidney transplantation in a three-year-old child with primary hyperoxaluria type 1 and complete thrombosis of the inferior vena cava. / Khan, Zahida; Sciveres, Marco; Salis, Paola; Minervini, Marida; Maggione, Giuseppe; Cintorino, Davide; Riva, Silvia; Gridelli, Bruno; Emma, Francesco; Spada, Marco.

In: Pediatric Transplantation, Vol. 15, No. 4, 06.2011.

Research output: Contribution to journalArticle

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