Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases

Single-centre experience

Naresh P. Shanmugam, Joseph J. Valamparampil, Mettu Srinivas Reddy, Khoula Julenda Al Said, Khalid Al-Thihli, Nadia Al-Hashmi, Emtithal Al-Jishi, Hasan Mohamed Ali Isa, Anil B. Jalan, Mohamed Rela

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Purpose: Auxiliary partial orthotopic liver transplantation (APOLT) in metabolic liver disease (MLD) has the advantage of correcting the metabolic defect, preserving the native liver for gene therapy in the future with the possibility of withdrawal of immunosuppression. Methods: Retrospective analysis of safety and efficacy of APOLT in correcting the underlying defect and its impact on neurological status of children with MLD. Results: A total of 13 APOLT procedures were performed for MLD during the study period. The underlying aetiologies being propionic acidemia (PA)-5, citrullinemia type 1 (CIT1)-3 and Crigler-Najjar syndrome type 1 (CN1)-5 cases respectively. Children with PA and CIT1 had a median of 8 and 4 episodes of decompensation per year, respectively, before APOLT and had a mean social developmental quotient (DQ) of 49 (<3 standard deviations) as assessed by Vineland Social Maturity Scale prior to liver transplantation. No metabolic decompensation occurred in patients with PA and CIT1 intraoperatively or in the immediate post-transplant period on protein-unrestricted diet. Patients with CN1 were receiving an average 8–15 h of phototherapy per day before APOLT and had normal bilirubin levels without phototherapy on follow-up. We have 100% graft and patient survival at a median follow-up of 32 months. Progressive improvement in neurodevelopment was seen in children within 6 months of therapy with a median social DQ of 90. Conclusions: APOLT is a safe procedure, which provides good metabolic control and improves the neurodevelopment in children with selected MLD.

Original languageEnglish
Title of host publicationJIMD Reports
PublisherSpringer
Pages29-36
Number of pages8
DOIs
Publication statusPublished - Jan 1 2019

Publication series

NameJIMD Reports
Volume45
ISSN (Print)2192-8304
ISSN (Electronic)2192-8312

Fingerprint

Metabolic Diseases
Liver
Liver Transplantation
Liver Diseases
Citrullinemia
Propionic Acidemia
Phototherapy
Crigler-Najjar Syndrome
Period Circadian Proteins
Graft Survival
Bilirubin
Genetic Therapy
Immunosuppression
Gene therapy
Transplants
Defects
Diet
Safety
Nutrition
Grafts

Keywords

  • Auxiliary partial orthotopic liver transplantation
  • Citrullinemia type 1
  • Crigler-Najjar syndrome type 1
  • Metabolic liver disease
  • Propionic acidemia

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)

Cite this

Shanmugam, N. P., Valamparampil, J. J., Reddy, M. S., Al Said, K. J., Al-Thihli, K., Al-Hashmi, N., ... Rela, M. (2019). Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases: Single-centre experience. In JIMD Reports (pp. 29-36). (JIMD Reports; Vol. 45). Springer. https://doi.org/10.1007/8904_2018_137

Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases : Single-centre experience. / Shanmugam, Naresh P.; Valamparampil, Joseph J.; Reddy, Mettu Srinivas; Al Said, Khoula Julenda; Al-Thihli, Khalid; Al-Hashmi, Nadia; Al-Jishi, Emtithal; Isa, Hasan Mohamed Ali; Jalan, Anil B.; Rela, Mohamed.

JIMD Reports. Springer, 2019. p. 29-36 (JIMD Reports; Vol. 45).

Research output: Chapter in Book/Report/Conference proceedingChapter

Shanmugam, NP, Valamparampil, JJ, Reddy, MS, Al Said, KJ, Al-Thihli, K, Al-Hashmi, N, Al-Jishi, E, Isa, HMA, Jalan, AB & Rela, M 2019, Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases: Single-centre experience. in JIMD Reports. JIMD Reports, vol. 45, Springer, pp. 29-36. https://doi.org/10.1007/8904_2018_137
Shanmugam NP, Valamparampil JJ, Reddy MS, Al Said KJ, Al-Thihli K, Al-Hashmi N et al. Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases: Single-centre experience. In JIMD Reports. Springer. 2019. p. 29-36. (JIMD Reports). https://doi.org/10.1007/8904_2018_137
Shanmugam, Naresh P. ; Valamparampil, Joseph J. ; Reddy, Mettu Srinivas ; Al Said, Khoula Julenda ; Al-Thihli, Khalid ; Al-Hashmi, Nadia ; Al-Jishi, Emtithal ; Isa, Hasan Mohamed Ali ; Jalan, Anil B. ; Rela, Mohamed. / Auxiliary partial orthotopic liver transplantation for monogenic metabolic liver diseases : Single-centre experience. JIMD Reports. Springer, 2019. pp. 29-36 (JIMD Reports).
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abstract = "Purpose: Auxiliary partial orthotopic liver transplantation (APOLT) in metabolic liver disease (MLD) has the advantage of correcting the metabolic defect, preserving the native liver for gene therapy in the future with the possibility of withdrawal of immunosuppression. Methods: Retrospective analysis of safety and efficacy of APOLT in correcting the underlying defect and its impact on neurological status of children with MLD. Results: A total of 13 APOLT procedures were performed for MLD during the study period. The underlying aetiologies being propionic acidemia (PA)-5, citrullinemia type 1 (CIT1)-3 and Crigler-Najjar syndrome type 1 (CN1)-5 cases respectively. Children with PA and CIT1 had a median of 8 and 4 episodes of decompensation per year, respectively, before APOLT and had a mean social developmental quotient (DQ) of 49 (<3 standard deviations) as assessed by Vineland Social Maturity Scale prior to liver transplantation. No metabolic decompensation occurred in patients with PA and CIT1 intraoperatively or in the immediate post-transplant period on protein-unrestricted diet. Patients with CN1 were receiving an average 8–15 h of phototherapy per day before APOLT and had normal bilirubin levels without phototherapy on follow-up. We have 100{\%} graft and patient survival at a median follow-up of 32 months. Progressive improvement in neurodevelopment was seen in children within 6 months of therapy with a median social DQ of 90. Conclusions: APOLT is a safe procedure, which provides good metabolic control and improves the neurodevelopment in children with selected MLD.",
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