Farese Stefan, Trost Nicolas, Candinas Daniel, Huynh-Do Uyen
Division of Nephrology and Hypertension, University of Bern Medical School, Inselspital, Freiburgstrasse 15, 3010, Berne, Switzerland.
Nephrol Dial Transplant. 2005 Nov;20(11):2557-60. doi: 10.1093/ndt/gfi019. Epub 2005 Aug 2.
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.
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.
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.
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.
为弥补尸体器官的短缺，需要新的方法来扩大供体库。在此，我们报告一例多米诺肝移植（DLT）病例，使用的器官取自一名患有原发性高草酸尿症（PHO）的复合杂合子患者，该患者接受了肝肾联合移植。DLT受者出现了早期肾衰竭并伴有草酸尿。在这种情况下，进展为肾衰竭并伴有草酸中毒的时间尚不清楚，但根据动物数据，我们推测钙调神经磷酸酶抑制剂可能起有害作用。
对一名52岁患有PHO的男性患者进行了尸体肝肾联合移植。他的肝脏被用于一名64岁患有不可切除但局限性胆管癌的患者。
虽然PHO供体的病程平稳，但在DLT受者术后早期，出现了依赖透析的肾衰竭并伴有高草酸尿。肾活检组织学显示大量草酸钙晶体沉积是主要病因。
将PHO器官用于边缘受者的DLT对于肝脏移植功能而言是一种可能的治疗方法。然而，它可能会以不可预测的方式对受者的肾脏结局产生负面影响，尤其是在同时使用环孢素的情况下。因此，我们建议，尽管应推广DLT，但此类手术最好排除PHO器官。
