Liver transplantation in two cases of propionic acidaemia
| Autor: | Adrian C. Sewell, F. Poggi-Travert, J. S. Schlenzig, Yann Revillon, Daniel Rabier, Pierre Kamoun, Dominique Jan, J. M. Saudubray, J. Laurent, U.A.H. Wendel |
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| Rok vydání: | 1995 |
| Předmět: |
Male
Central Nervous System medicine.medical_treatment Liver transplantation Cardiovascular Gastroenterology Liver Function Tests Neural Tube Defects Metabolic Processes (Non MeSH) Genetics (clinical) Hereditary Diseases Mental Disorders Inborn Errors Mitochondrial Myopathies Skeletal Neuromuscular Diseases Lipids Thrombosis Mitochondria Proteinuria Chemistry surgical procedures operative Muscle Female Homocystinuria Acidosis medicine.medical_specialty Urinary system Pregnancy Complications Cardiovascular Inborn errors of metabolism Biochemical Excretion Clinical Metabolic Diseases Internal medicine Diabetes mellitus medicine Genetics Humans Genetics Biochemical Vascular Diseases Erfelijke stofwisselingsziekten Muscle Skeletal business.industry Vanishing bile duct syndrome Infant Newborn Metabolic acidosis Fibroblasts medicine.disease Liver Transplantation Surgery Pregnancy Complications Metabolism Chemistry Clinical Mutation Propionates business Energy Metabolism Metabolism Inborn Errors |
| Zdroj: | Journal of Inherited Metabolic Disease, 18, 448-461 Journal of Inherited Metabolic Disease, 18, pp. 448-461 |
| ISSN: | 0141-8955 |
| Popis: | Orthotopic liver transplantation (OLT) was performed in two patients with propionic acidaemia, a 7-year-old boy and a 9-year-old girl, diagnosed with a severe neonatal form with high risk of metabolic decompensation. In both cases the metabolic liver functions recovered within the 12 postoperative hours; no clinical symptoms of propionic acid toxicity, metabolic acidosis, severe hyperammonaemia, hyperglycinaemia or haematological abnormalities were observed. In both cases insulin-dependent diabetes mellitus occurred early after OLT (persisting in the boy's case). Severe post-transplantation complications were observed (acute rejection and CMV infection in both patients) which did not trigger metabolic decompensation. The boy developed chronic rejection and vanishing bile duct syndrome due to incomplete hepatic arterial thrombosis. He required permanent in-patient care with chronic hyperammonaemia and neurological sequelae involving the basal ganglia and died 15 months after OLT. The girl left hospital after 2 months and is presently leading a normal life with almost no dietary protein restriction (40 g protein per day). Urinary urea excretion and daily protein intake increased after liver transplantation. Propionyl- and tiglylglycine disappeared immediately after OLT. Urinary methylcitrate and 3-hydroxypropionate remained at concentrations corresponding to those before OLT. However, the total of all characteristic metabolites of organic acid analysis was reduced to 50-60% of the values before OLT in both patients. Propionylcarnitine was still detected at significant concentrations. Plasma odd-chain fatty acid concentrations decreased continuously after OLT only in the girl's case. Tissue of both transplanted livers showed increased odd-chain fatty acid concentrations 9 and 15 months after OLT, respectively, in both patients. We consider that at present OLT should only be performed in severe forms of propionic acidaemia. |
| Databáze: | OpenAIRE |
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