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Combined Liver and Kidney Transplant in Acute Intermittent Porphyria: A Case Report

Gustavo de Sousa Arantes Ferreira, Livia Claudio de Oliveira, Luiz Roberto de Sousa Ulisses, Andre Luis Conde Watanabe, Isabela Novais Medeiros, Helen Souto Siqueira Cardoso, Inara Creão da Costa Alves, Tiago Martins de Almeida, Laura Viana de Lima, Renata Pereira Fontoura, Eduardo Resende Sousa e Silva, Pollyana Lopes de Araújo

(Department of Liver Transplantation, Institute of Cardiology of the Federal District (ICDF), Brasília, Brazil)

Am J Case Rep 2020; 21:e927832

DOI: 10.12659/AJCR.927832

BACKGROUND: Acute intermittent porphyria is an inherited disease caused by a defect in heme biosynthesis, with accumulation of neurotoxic metabolites leading to acute neurovisceral symptoms. Some patients develop long-term neurological and renal damage after the acute episodes, many of them requiring hemodialysis. Since heme production in the human body occurs predominantly in the bone marrow and liver, liver transplantation has been shown to significantly reduce the production of neurotoxic metabolites, effectively controlling the disease. Patients with severe acute intermittent porphyria who have chronic kidney failure may benefit from combined kidney and liver transplant. Only 2 uses of this approach have been previously reported in the literature.
CASE REPORT: We report here the case of a 19-year-old male patient who received a combined liver and kidney transplant for the treatment of acute intermittent porphyria. He presented the first symptoms of the disease 4 years before the procedure, with abdominal pain and significant neurological impairment, with weakness requiring prolonged mechanical ventilation. He also had chronic kidney failure secondary to the porphyria. A combined liver and kidney transplant was performed, with no intraoperative complications. The explanted liver showed light siderosis, as well as portal and perisinusoidal fibrosis at microscopy. At 3.5 years of follow-up, he remains clinically well, with normal hepatic and renal function, had had no further acute porphyria episodes, and shows progressive neurological recovery.
CONCLUSIONS: This case demonstrates that combined liver and kidney transplant can be a curative treatment for patients with severe acute intermittent porphyria associated with end-stage renal failure. The patient shows satisfactory long-term function of both grafts, with no clinical or biochemical signs of porphyria recurrence.

Keywords: Hematologic Diseases, Kidney Transplantation, Liver Transplantation, Porphyria, Acute Intermittent, Porphyrias, renal insufficiency

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