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Two-step transplantation for primary hyperoxaluria: A winning strategy to prevent progression of systemic oxalosis in early onset renal insufficiency cases.
[primary hyperoxaluria type 1]
Several
transplant
strategies
for
PH
1
have
been
proposed
,
and
LT
is
performed
to
correct
the
metabolic
defects
.
The
patients
with
PH
1
often
suffer
from
ESRD
and
require
simultaneous
LKT
,
which
leads
to
a
long
wait
due
to
the
shortage
of
suitable
organ
donors
.
Five
patients
with
PH
1
underwent
LDLT
at
our
institute
.
Three
of
the
five
patients
were
under
dialysis
before
LDLT
,
while
the
other
two
patients
were
categorized
as
CKD
stage
3
.
An
isolated
LDLT
was
successfully
performed
in
all
but
our
first
case
,
who
had
complicated
postoperative
courses
and
consequently
died
due
to
sepsis
after
retransplantation
.
The
renal
function
of
the
patients
with
CKD
stage
3
was
preserved
after
LDLT
.
On
the
other
hand
,
our
second
case
with
ESRD
underwent
successful
LDKT
six
Â
months
after
LDLT
,
and
our
infant
case
is
waiting
for
the
subsequent
KT
without
any
post-
LDLT
complications
after
the
early
establishment
of
PD
.
In
conclusion
,
a
two
-step
transplant
strategy
may
be
needed
as
a
life-saving
option
for
patients
with
PH
1
and
may
be
possible
even
in
small
infants
with
systemic
oxalosis
.
While
waiting
for
a
subsequent
KT
,
an
early
resumption
of
PD
should
be
considered
from
the
perspective
of
the
long
-term
requirement
of
RRT
.
Diseases
Validation
Diseases presenting
"long-term requirement"
symptom
primary hyperoxaluria type 1
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