Renal outcome and plasma methylmalonic acid levels after isolated or combined liver or kidney transplantation in patients with methylmalonic acidemia: A multicenter analysis

被引:10
|
作者
Dello Strologo, Luca [1 ]
Spada, Marco [2 ,8 ]
Vici, Carlo Dionisi [3 ]
Degli Atti, Marta Ciofi [4 ]
Rheault, Michelle [5 ]
Bjerre, Anna Kristina [6 ,22 ]
Boyer, Olivia [7 ]
Calvo, Pier Luigi [8 ]
D'Antiga, Lorenzo [9 ]
Harshman, Lyndsay A. [10 ]
Hoerster, Friederike [11 ]
Koelker, Stefan [11 ]
Jahnukainen, Timo [12 ]
Knops, Noel [13 ,14 ]
Krug, Pauline [7 ]
Krupka, Kai [11 ]
Lee, Angela [15 ]
Levtchenko, Elena [13 ,14 ]
Marks, Stephen D. [16 ]
Stojanovic, Jelena [16 ]
Martelli, Laura [9 ]
Mazariegos, George [17 ]
Montini, Giovanni [18 ]
Shenoy, Mohan [19 ]
Sidhu, Sangeet [19 ]
Spada, Marco [2 ,8 ]
Tangeras, Trine [6 ]
Testa, Sara [18 ]
Vijay, Suresh [20 ]
Wac, Katarzyna [15 ]
Wennberg, Lars [21 ]
Concepcion, Waldo [15 ]
Garbade, Sven F. [11 ]
Toenshoff, Burkhard [11 ]
机构
[1] Bambino Gesu Childrens Hosp IRCCS, Nephrol, Rome, Italy
[2] Bambino Gesu Childrens Hosp IRCCS, Surg, Rome, Italy
[3] Bambino Gesu Childrens Hosp IRCCS, Metab, Rome, Italy
[4] Bambino Gesu Childrens Hosp IRCCS, Epidemiol, Rome, Italy
[5] Univ Minnesota, Childrens Hosp, Minneapolis, MN 55455 USA
[6] Oslo Univ Hosp, Dept Paediat & Adolescent Med, Oslo, Norway
[7] Univ Paris Cite, Inst Imagine, MARHEA, Hop Necker Enfant Malad, Paris, France
[8] Univ Torino, Dept Pediat, Turin, Italy
[9] Hosp Papa Giovanni XXIII, Paediat Hepatol Gastroenterol & Transplantat, Bergamo, Italy
[10] Univ Iowa, Iowa City, IA 52242 USA
[11] Univ Childrens Hosp, Dept Pediat 1, Heidelberg, Germany
[12] New Childrens Hosp Helsinki, Dept Pediat Nephrol & Transplantat, Helsinki, Finland
[13] Univ Hosp Leuven, Dept Pediat Nephrol & Growth & Regenerat, Leuven, Belgium
[14] Univ Leuven, Leuven, Belgium
[15] Stanford Univ, Div Transplantat, Sch Med, Stanford, CA 94305 USA
[16] UCL, NIHR Great Ormond St Hosp Biomed Res Ctr, Great Ormond St Inst Child Hlth, London, England
[17] UPMC Childrens Hosp Pittsburgh, Pediat Transplant Surg, Pittsburgh, PA USA
[18] Fdn IRCCS Ca Granda, Osped Maggiore Policlin Milan, Pediat Nephrol Dialysis & Transplantat Unit, Milan, Italy
[19] Royal Manchester Childrens Hosp, Pediat Nephrol, Manchester, Lancs, England
[20] Birmingham Childrens Hosp NHS Fdn Trust, Pediat, Birmingham, W Midlands, England
[21] Karolinska Univ Hosp Stockholm, Dept Transplantat Surg, Stockholm, Sweden
[22] Univ Oslo, Inst Clin Med, Oslo, Norway
关键词
Methylmalonic acidemia; Methylmalonic acid; Estimated glomerular filtration rate; Kidney transplantation; Liver transplantation; Combined liver-kidney transplantation; MUT(0);
D O I
10.1016/j.ymgme.2022.09.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Methylmalonic acidemia (MMAemia) is characterized by accumulation of methylmalonic acid (MMA) in all body tissues. To minimize disease-related complications, isolated kidney (KTx), liver (LTx) or com-bined liver-kidney transplantation (LKTx) have been suggested. However, the impact of these different trans -plant strategies on outcome are unclear.Methods: In this multicenter retrospective observational study, we compared plasma MMA levels and estimated glomerular filtration rate (eGFR) data of 83 patients. Sixty-eight patients (82%) had a mut0-type MMAemia, one patient had a mut--type MMAemia, and seven (7.3%) had an inherited defect in cobalamin metabolism (cblA-or cblB-type MMAemia). Median observation period was 3.7 years (0-15.1 years).Results: Twenty-six (31%) patients underwent KTx, 24 (29%) LTx and 33 (40%) LKTx. Posttransplant, mean plasma MMA concentration significantly decreased in all three cohorts; but at month 12, plasma MMA in KTx (1372 & PLUSMN; 1101 mu mol/L) was 7.8-fold higher than in LTx (176 & PLUSMN; 103 mu mol/L; P < 0.001) and 6.4-fold higher than in LKTx (215 & PLUSMN; 110 mu mol/L; P < 0.001). Comparable data were observed at month 24. At time of transplan-tation, mean eGFR in KTx was 18.1 & PLUSMN; 24.3 mL/min/1.73 m2, in LTx 99.8 & PLUSMN; 29.9 mL/min/1.73 m2, and in LKTx 31.5 & PLUSMN; 21.2 mL/min/1.73 m2. At month 12 posttransplant, mean eGFR in KTx (62.3 & PLUSMN; 30.3 mL/min/1.73 m2) was 33.4% lower than in LTx (93.5 & PLUSMN; 18.3 mL/min/1.73 m2; P = 0.0053) and 25.4% lower than in LKTx (83.5 & PLUSMN; 26.9 mL/min/1.73 m2; P = 0.0403).Conclusions: In patients with isolated MMAemia, LTx and LKTx lead to markedly lower plasma MMA levels during the first 2 years posttransplant than KTx and are associated with a better preservation of kidney function. LTx should therefore be part of the transplant strategy in MMAemia.(c) 2022 Elsevier Inc. All rights reserved.
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收藏
页码:265 / 272
页数:8
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