TRANSPLANTATION FOR PRIMARY HYPEROXALURIA IN THE USA

US data were sought for transplantation in primary hyperoxaluria (PH). The USRDS recorded 194 patients since 1974. By lifetable analysis, su rvival was better for transplanted than for non-transplanted patients (P < 0.001), even after trimming data for age < 55 and end-stage renal disease since 1985 (63 patients, 39 transplanted, 24 not transplanted ). Transplant survival was longer for living related donor (21) vs cad averic (17) transplants. Twenty-nine kidney transplants in 22 children were registered in NAPRTCS. Interview data with physicians showed tha t eight of 17 living related donor kidneys functioned well, three were borderline and six were lost. All six cadaver kidneys were lost. Four of six kidney-liver transplants functioned, and two died. United Netw ork for Organ Sharing recorded 13 kidney-liver transplants in 11 patie nts. Six initially functioned well; two were retransplanted. Ultimatel y seven lived and four died. Overall, transplant is better than no tra nsplant; cadaver donation results are poor; living related kidney dona tion can succeed; and kidney-liver transplant is still problematic in the US, and rarely follows appropriate investigation. Until more coope rative effort can be achieved, isolated kidney living related donor tr ansplant is preferable, and does not preclude kidney-liver transplant later.