title: Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria.
abstract: Enteric hyperoxaluria (EH) occurs with a rate of 5-24% in patients with inflammatory bowel disease, ileal resection and modern bariatric surgery. The excessive absorption of calcium oxalate causes chronic kidney disease (CKD) in patients with EH. In the literature, a single experience was reported in combined intestine-kidney transplantation (CIKTx) in patients with CKD due to EH.
  
  
  
  After a report of 2 successful cases of CIKTx in patients with EH and CKD, one was performed at our center in a 59-year-old Caucasian female who developed intestinal failure with total parenteral nutrition (TPN) dependence after a complication post-bariatric surgery. Before CIKTx, she underwent kidney transplantation alone (KTA) twice, which failed due to oxalate nephropathy.
  
  
  
  In July 2014, the patient underwent CIKTx and bilateral allograft nephrectomy to avoid EH and oxalate stone burden. The postoperative course was complicated with acute tubular necrosis due to the use of high pressors related to perioperative bleeding. The patient was discharged 79 days after CIKTx with a serum creatinine (sCr) of 1.2 mg/dl and free of TPN. Her sCr increased at 7 months and a renal biopsy showed oxalate nephropathy. SLC26A6 (oxalate transporter) staining was significantly diminished in native duodenum/rectum as well as in intestinal allograft compared to control.
  
  
  
  KTA in patients with CKD secondary to EH should not be recommended due to high risk of recurrence. Although other centers showed good long-term outcomes in CIKTx, our patient experienced recurrence of EH due to oxalate transporter defect, early kidney allograft dysfunction and prolonged antibiotic use.
authors.affiliation: Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind., USA.
authors.forename: Burcin
authors.initials: B
authors.lastname: Ekser
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: Chandrashekhar A
authors.initials: CA
authors.lastname: Kubal
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: John A
authors.initials: JA
authors.lastname: Powelson
authors.forename: Santosh
authors.initials: S
authors.lastname: Nagaraju
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Phillips
authors.forename: Romil
authors.initials: R
authors.lastname: Saxena
authors.forename: William C
authors.initials: WC
authors.lastname: Goggins
mesh_terms: D064591:Allografts / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D016913:Blood Component Transfusion; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002129:Calcium Oxalate / Q000493:pharmacokinetics* / Q000652:urine; D002432:Cecum / Q000601:surgery; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D006959:Hyperoxaluria / Q000150:complications / Q000473:pathology / Q000601:surgery*; D045822:Intestinal Volvulus / Q000209:etiology / Q000601:surgery; D007422:Intestines / Q000473:pathology / Q000637:transplantation*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D007683:Kidney Tubular Necrosis, Acute / Q000209:etiology; D026901:Membrane Transport Proteins / Q000378:metabolism; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000076988:Sulfate Transporters; D014184:Transplantation, Homologous / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D026901:Membrane Transport Proteins; C439529:SLC26A6 protein, human; D000076988:Sulfate Transporters; D014662:Vasoconstrictor Agents; D002129:Calcium Oxalate; D003404:Creatinine