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Bilateral native nephrectomy reduces systemic oxalate level after combined liver‐kidney transplant: A case report
Author(s) -
Villani Vincenzo,
Gupta Neena,
Elias Nahel,
Vagefi Parsia A.,
Markmann James F.,
Paul Elahna,
Traum Avram Z.,
Yeh Heidi
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.12901
Subject(s) - medicine , oxalate , hemodialysis , kidney , primary hyperoxaluria , transplantation , bilateral nephrectomy , nephrectomy , urology , kidney transplantation , liver transplantation , calcium oxalate , kidney disease , gastroenterology , endocrinology , urinary system , chemistry , organic chemistry
Primary hyperoxaluria type 1 ( PH 1) is a rare liver enzymatic defect that causes overproduction of plasma oxalate. Accumulation of oxalate in the kidney and subsequent renal failure are fatal to PH 1 patients often in pediatric age. Combined liver and kidney transplantation is the therapy of choice for end‐stage renal disease due to PH 1. Levels of plasma oxalate remain elevated for several months after liver transplantation, as the residual body oxalate is slowly excreted. Patients with persistent hyperoxaluria after transplant often require hemodialysis, and accumulation of residual oxalate in the kidney can induce graft dysfunction. As the native kidneys are the main target of calcium oxalate accumulation, we postulated that removal of native kidneys could drastically decrease total body oxalate levels after transplantation. Here, we report a case of bilateral nephrectomy at the time of combined liver‐kidney transplantation in a pediatric PH 1 patient. Bilateral nephrectomy induced a rapid decrease in plasma oxalate to normal levels in less than 20 days, compared to the several months reported in the literature. Our results suggest that removal of native kidneys could be an effective strategy to decrease the need for hemodialysis and the risk of renal dysfunction after combined liver‐kidney transplantation in patients with PH 1.