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Journal Article Comparative Study Multicenter Study Ppublish

PubMed: 42847256 DOI: 10.1111/petr.70484

Sequential Versus Combined Liver-Kidney Transplantation in Pediatric Primary Hyperoxaluria Type 1: A Multi-Center Comparative Cohort Analysis.

Pediatr Transplant 30(10):e70484

Authors: Ryuji Komine, Jagadeesh Menon Vr, Hyun Hwa Choi, Kang-Wong Lee, Toru Ikegami, Yuji Soejima, Mureo Kasahara

Affiliations

  • Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
  • Department of Pediatric Gastroenterology, Hepatology and Nutrition, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
  • Department of Hepato-Biliary-Pancreas Surgery, Seoul National University Hospital, Seoul, Korea.
  • Hepatobiliary and Pancreas Surgery, Jikei University School of Medicine, Tokyo, Japan.
  • Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan.

Abstract

BACKGROUND

Combined liver-kidney transplantation is the standard treatment for pediatric primary hyperoxaluria Type 1 with advanced kidney disease, but sequential liver-kidney transplantation is increasingly used where living-donor transplantation predominates. Direct comparisons between these strategies remain limited.

METHODS

We retrospectively analyzed 19 pediatric patients with chronic kidney disease Stage 4 or higher who completed combined (n = 10) or sequential (n = 9) liver-kidney transplantation for primary hyperoxaluria Type 1 across four countries. The comparative analysis was restricted to patients who received both organs; patients who underwent liver transplantation without subsequent kidney transplantation were excluded.

RESULTS

Patients who completed sequential transplantation had earlier onset of primary hyperoxaluria Type 1-related symptoms (3.0 vs. 12.0 months, p = 0.029) and lower estimated glomerular filtration rate at liver transplantation (16.5 vs. 36.5 mL/min/1.73 m 2, p = 0.043) than those who completed combined transplantation. Among recipients who completed both procedures, major perioperative complications and patient survival did not differ significantly; no perioperative deaths occurred after the liver transplantation stage among patients who subsequently completed sequential transplantation. Death-censored kidney graft survival was higher in the completed-sequential group (log-rank p = 0.045). Among patients who completed sequential transplantation, an interval exceeding 6 months between liver and kidney transplantation showed a descriptive trend toward better preserved kidney function.

CONCLUSIONS

Among pediatric patients with primary hyperoxaluria Type 1 who completed both liver and kidney transplantation, sequential transplantation was associated with favorable observed kidney graft outcomes. These findings describe outcomes among recipients who completed both procedures and should not be interpreted as outcomes of an initially intended sequential strategy.

MeSH

Kidney Diseases, Liver Transplantation, Hyperoxaluria, Primary, Multiple Chronic Conditions, Hyperoxaluria, Kidney, Liver, Transplants, Kidney Transplantation, Transplantation