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.

[primary hyperoxaluria type 1]

PH 1 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 PH 1 is the most aggressive form of this disease , leading to early nephrocalcinosis , systemic oxalosis , and end-stage renal failure . Infantile PH 1 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 PH 1 . 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 PH 1 complicated by complete IVC thrombosis .

Diseases
Validation

Diseases presenting "limited number" symptom

22q11.2 deletion syndrome

achondroplasia

cholangiocarcinoma

congenital diaphragmatic hernia

dedifferentiated liposarcoma

dentinogenesis imperfecta

epidermolysis bullosa simplex

erythropoietic protoporphyria

liposarcoma

neonatal adrenoleukodystrophy

pleomorphic liposarcoma

primary hyperoxaluria type 1

proteus syndrome

trochlear dysplasia

well-differentiated liposarcoma

werner syndrome

wiskott-aldrich syndrome

x-linked adrenoleukodystrophy

zellweger syndrome

You can validate or delete this automatically detected symptom