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Pediatric Nephrology (Berlin, Germany) Aug 2021Primary hyperoxaluria type 1 (PH1) is characterized by hepatic overproduction of oxalate and often results in kidney failure. Liver-kidney transplantation is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Primary hyperoxaluria type 1 (PH1) is characterized by hepatic overproduction of oxalate and often results in kidney failure. Liver-kidney transplantation is recommended, either combined (CLKT) or sequentially performed (SLKT). The merits of SLKT and the place of an isolated kidney transplant (KT) in selected patients are unsettled. We systematically reviewed the literature focusing on patient and graft survival rates in relation to the chosen transplant strategy.
METHODS
We searched MEDLINE and Embase using a broad search string, consisting of the terms 'transplantation' and 'hyperoxaluria'. Studies reporting on at least four transplanted patients were selected for quality assessment and data extraction.
RESULTS
We found 51 observational studies from 1975 to 2020, covering 756 CLKT, 405 KT and 89 SLKT, and 51 pre-emptive liver transplantations (PLT). Meta-analysis was impossible due to reported survival probabilities with varying follow-up. Two individual high-quality studies showed an evident kidney graft survival advantage for CLKT versus KT (87% vs. 14% at 15 years, p<0.05) with adjusted HR for graft failure of 0.14 (95% confidence interval: 0.05-0.41), while patient survival was similar. Three other high-quality studies reported 5-year kidney graft survival rates of 48-89% for CLKT and 14-45% for KT. PLT and SLKT yielded 1-year patient and graft survival rates up to 100% in small cohorts.
CONCLUSIONS
Our study suggests that CLKT leads to superior kidney graft survival compared to KT. However, evidence for merits of SLKT or for KT in pyridoxine-responsive patients was scarce, which warrants further studies, ideally using data from a large international registry.
Topics: Graft Survival; Humans; Hyperoxaluria, Primary; Kidney Transplantation; Liver Transplantation; Retrospective Studies; Treatment Outcome
PubMed: 33830344
DOI: 10.1007/s00467-021-05043-6 -
Scandinavian Journal of Urology Dec 2020Metabolic factors underlying the recent increase in stone prevalence over the past decades are not well understood. Herein, we evaluate temporal, geographic and... (Comparative Study)
Comparative Study
BACKGROUND
Metabolic factors underlying the recent increase in stone prevalence over the past decades are not well understood. Herein, we evaluate temporal, geographic and gender-specific trends in metabolic risk factors in recurrent kidney stone formers.
PATIENTS AND METHODS
A systematic literature review of metabolic risk factors for stone formation was conducted, inclusive of the last four decades. Studies with inadequate 24 h urine metabolic data, pediatric or those with less than 50 patients were excluded. The primary outcome was prevalence of each metabolic risk factor, compared between studies published prior to the year 2000 vs those following. Geographic and gender differences were secondary outcomes.
RESULTS
Twenty-eight articles met inclusion criteria, of which 10 ( = 1578) were published prior to the year 2000 and 18 ( = 8747) were published thereafter. Comparing these groups, an increase in hyperoxaluria (29% vs 33%; = 0.002), hypercalciuria (35 vs 36%; = 0.446), hyperuricosuria (17% vs 22%; < 0.0001), low urine volume (28 vs 38%; < 0.0001) and hypocitraturia (23% vs 44%; < 0.0001) was observed. The prevalence of hyperoxaluria, hypercalciuria, hyperuricosuria and hypocitraturia were significantly higher in males. There were also significant geographical differences, with higher prevalence of hyperoxaluria and hypocitraturia in non-Western countries and higher prevalence of hypercalciuria in Western countries. Prevalence of hyperoxaluria is increasing in the US.
CONCLUSION
Prevalence of metabolic risk factors for nephrolithiasis significantly increased in recent years. These findings are hypothesis-generating and may provide valuable insight into the epidemiology, prevention and management of recurrent stone disease. Dietary modifications and innovative medical therapies are needed to decrease metabolic risk factors underlying nephrolithiasis.
Topics: Citric Acid; Female; Global Health; Humans; Hypercalciuria; Hyperoxaluria; Kidney Calculi; Male; Metabolic Diseases; Recurrence; Risk Factors; Sex Factors; Time Factors; Uric Acid
PubMed: 33185135
DOI: 10.1080/21681805.2020.1840430