Oxalate kinetics and reversal of the complications after orthotopic liver transplantation in a patient with primary hyperoxalosis type 1 awaiting renal transplantation

We present the case of a young woman with end-stage renal disease secondary to primary hyperoxaluria type 1, who after 3 years and 6 months of mainten ance hemodialysis, and despite intensification of the dialytic treatment, d eveloped severe livedo reticularis in her extremities leading to ischemic c utaneous ulcerations, necessitating continuous intravenous infusion of narc otics for pain control. She received a liver transplant after native hepate ctomy. However, due to positive crossmatch, she could not receive a kidney from that donor. After transplantation, following serial serum oxalate leve ls, the hemodialysis regimen was safely reduced from 4 h daily to 3 h three times weekly. Over the course of 6 weeks after liver transplantation, her livedo reticularis resolved, the ischemic ulcers markedly improved, she was weaned off all pain medications, and her erythropoietin-resistant anemia r esolved. Our results suggest that in patients with primary hyperoxaluria ty pe 1, who have received a liver transplant and are on maintenance hemodialy sis, after serial serum oxalate determinations, some may safely be changed to a thrice-weekly maintenance hemodialysis regimen. Moreover, with this re gimen the complications of systemic oxalosis can reverse.