# Long‐Term Follow‐Up of Patients With Transaldolase Deficiency

## TL;DR

This study follows patients with transaldolase deficiency over 20 years, revealing long-term complications like liver and kidney failure, and the need for organ transplants.

## Contribution

The study provides the first long-term multicenter data on transaldolase deficiency, highlighting new insights into kidney involvement and transplantation needs.

## Key findings

- Liver involvement is universal, with 10 patients developing cirrhosis and 4 undergoing liver transplantation.
- Chronic kidney failure occurred in 5 patients, with kidney transplantation considered in 2 adults, a novel observation for this disease.
- Cardiac issues like PFO and ventricular dysfunction were common, along with chronic cytopenia and endocrine disorders.

## Abstract

Transaldolase (TALDO) deficiency has a well‐characterized phenotype. However, there are few large cohort studies, and little is known about the long term, including the need for organ transplantation. Our aim was to share a long multicenter experience in managing these patients. We retrospectively collected data on 16 patients followed for up to 20 years. Liver involvement was present in all patients, with six presenting liver failure at birth. During long‐term follow‐up, 10 patients developed cirrhosis and four underwent liver transplantation (LTx). Two patients died from severe liver failure in the first months of life; persistent weight below 4 kg precluded LTx. A third patient died from posttransplant complications at 6 months of life. Five patients developed chronic kidney failure, and in two of them kidney transplantation was considered after the age of 20 years. Patent foramen ovale (PFO) was the most frequent cardiac finding; cardiomyopathy or ventricular dysfunction was diagnosed in five patients. Twelve patients developed chronic cytopenia, all presenting with thrombocytopenia. Hypergonadotropic hypogonadism was found in seven patients; two others developed secondary adrenal cortisol insufficiency and primary hypothyroidism requiring replacement therapy. Mild neurocognitive delay was observed only in a few cases. We described different patterns of liver disease progression. Transplantation should be early considered if indicated for liver insufficiency; in the most severe patients with neonatal onset, achieving sufficient weight for transplantation may be challenging. Our preliminary data suggest that, in older patients, kidney involvement may also warrant consideration of kidney transplantation, which was not previously described for this disease.