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Byline: M. F. Gagnadoux (1), F. Lacaille (2), P. Niaudet (1), Y. Revillon (3), P. Jouvet (4), D. Jan (3), G. Guest (1), M. Charbit (1), M. Broyer (1) Keywords: Keywords Oxalosis; Renal transplant; Hepatorenal transplant Abstract: From 1990 to 2000, we performed eight liver-kidney transplants in eight children, aged 1--16 years, with end-stage renal failure (ESRF) due to primary hyperoxaluria (PH1). The duration of dialysis before transplantation ranged from 2 to 42 months (mean 14 months) and was &lt 1 year in four patients. Only the first patient underwent postoperative hemodialysis in the other five, we chose to induce maximal diuresis from the first hours with intravenous and intragastric hyperhydration (aY=3 l/m.sup.2 per day). High water intake with nocturnal tube hydration was maintained for 6 months to 5 years, as long as oxaluria exceeded 0.5 mmol/day. A quadruple sequential immunosuppressive regimen was used. Two patients died during liver graft surgery. The other six patients are alive and well, with a mean follow-up of 7.4 years (range 5--11 years). Patient and graft survival is 75% at 5 years. At latest follow-up, liver tests were normal in all six patients creatinine clearance ranged from 55 to 95 ml/min per 1.73 m.sup.2 (mean=74). Oxaluria was lower than 0.4 mmol/day in all patients (mean=0.22). The six patients underwent 15 renal biopsies, 1--11 years after transplantation. Chronic transplant nephropathy was present in four patients and mild cyclosporin nephrotoxicity in another. No oxalate crystals were seen and repeat ultrasonography has been consistently normal in all patients. The three patients with bone oxalosis showed progressive complete healing of bone lesions. All six children or adolescents now live a normal life. From this series, we conclude that early combined liver-kidney transplantation is the treatment of choice for children with ESRF due to primary hyperoxaluria. Author Affiliation: (1) Department of Pediatric Nephrology, Hopital Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France. marie-france.gagnadoux@nck.ap-hop-paris.fr, FR (2) Department of Hepatology, Hopital Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France, FR (3) Department of Surgery, Hopital Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France, FR (4) Department of Intensive Care, Hopital Necker-Enfants Malades, 149 rue de Sevres, 75743 Paris Cedex 15, France, FR Article note: Received: 7 June 2001 / Revised: 7 August 2001 / Accepted: 7 August 2001

Byline: A. Swiatecka-Urban (1), Clotilde Garcia (2), Dianne Feuerstein (3), Samuel Suzuki (4), Prasad Devarajan (2), Richard Schechner (3), Stuart Greenstein (3), Vivian Tellis (3), Frederick Kaskel (2) Keywords: Keywords Basiliximab; Tacrolimus; Target levels; Post-transplant lymphoproliferative disease; Post-transplant diabetes mellitus Abstract: Thirty-two children and adolescents received their renal transplant at the Montefiore Medical Center, in New York, between October 1996 and May 2000. Twenty-four patients received basiliximab, in addition to tacrolimus and steroids (basiliximab group). The remaining eight patients received only tacrolimus and steroids (non-basiliximab group). The 1-year patient survival rate was 100% in both groups. The 1-year graft survival rate was 87.5% for the basiliximab group and 75% for the non-basiliximab group (P=0.45). The rates of acute rejection in the basiliximab and non-basiliximab groups were 26% and 43%, respectively (P=0.36). However, in recipients with a$?3 HLA mismatches, the rate of acute rejection was zero in the basiliximab group, and 40% in the non-basiliximab group (P=0.04). The beneficial effect occurred despite the fact that tacrolimus was maintained at below the target levels. There were no adverse events directly attributable to the administration of basiliximab. There were no cases of opportunistic infections or post-transplant lymphoproliferative disease. In summary, addition of basiliximab to tacrolimus and prednisone significantly decreased the rate of acute rejection in well-matched patients. Moreover, this effect was manifest at lower, and therefore less toxic, tacrolimus levels. Author Affiliation: (1) Ira Greifer Pediatric Kidney Center, 3326 Bainbridge Avenue, Bronx, NY 10467, USA. ajaswurban001@worldnet.att.net, US (2) Department of Pediatrics, Division of Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA, US (3) Department of Surgery, Division of Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, US (4) Department of Biomedical Statistics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, US Article note: Received: 19 December 2000 / Revised: 23 April 2001 / Accepted: 24 April 2001