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Native Portal Vein Embolization for persistent Hyperoxaluria following Kidney and Auxiliary Partial Liver Transplantation
*Nahel Elias, Tatsuo Kawai, Dicken SC Ko, *Reza Saidi, *Nina Tolkoff-Rubin, *Stephan Wicky, A. Benedict Cosimi, Martin Hertl
Massachusetts General Hospital, Boston, MA

Objective:
To evaluate native portal vein embolization (PVE) for inducing hypertrophy and improved function of auxiliary partial liver transplantation (APLT)
Design:
We here report the first case of partial native PVE to induce hypertrophy of the APLT segment.
Setting:
Type 1 primary hyperoxaluria (PH1) causes renal failure, but isolated kidney transplantation (KT) is usually an unsuccessful treatment in these patients due to early recurrent oxalate stone formation.
Since liver transplantation (LT) corrects PH1 enzymatic defect, simultaneous APLT and KT have been recommended as the preferred treatment for these patients.
Advantages of APLT include preservation of the donor pool and retention of native liver function in the event of liver graft loss. However, APLT may occasionally not provide sufficient liver mass to correct the defect.
Patients:
Following initial APLT-KT; both allografts functioned well, but oxalate plasma levels did not normalize. We postulated the inadequate APLT hepatocyte mass resulted in persistent oxalate elevation.
Interventions:
We performed percutaneous trans-hepatic partial native PVE.
Main Outcome Measures:
Serum oxalate level.
Results:
The increased APLT portal flow and hypertrophy decreased serum oxalate levels to normal within one month and persisted afterward.
Conclusions:
We conclude that persistently elevated oxalate levels after combined APLT-KT for treatment of PH1 result from inadequate functional capacity of the APLT segment. This can be reversed by partial native PVE to decrease portal flow distribution to the competing native liver. This approach might be applicable to other scenarios where partial grafts have been transplanted to slowly replace native liver function


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IMPORTANT DATES
Abstract Submission Deadline:
May 5, 2014

Housing Deadline:
August 13, 2014

Early Bird Registration Deadline:
August 11, 2014
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