Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria

Burcin Ekser, Richard Mangus, Chandrashekhar A. Kubal, Jonathan A. Fridell, John A. Powelson, Santosh Nagaraju, Plamen Mihaylov, Carrie Phillips, Romil Saxena, William C. Goggins

Research output: Contribution to journalArticle

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Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalAmerican Journal of Nephrology
DOIs
StateAccepted/In press - Jul 14 2016

Fingerprint

Hyperoxaluria
Kidney Diseases
Kidney Transplantation
Intestines
Oxalates
Recurrence
Chronic Renal Insufficiency
Allografts
Bariatric Surgery
Total Parenteral Nutrition
Creatinine
Kidney
Calcium Oxalate
Nephrectomy
Serum
Inflammatory Bowel Diseases
Duodenum
Rectum
Necrosis
Staining and Labeling

Keywords

  • Enteric hyperoxaluria
  • Intestinal transplantation
  • Kidney transplantation
  • Secondary hyperoxaluria

ASJC Scopus subject areas

  • Nephrology

Cite this

Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria. / Ekser, Burcin; Mangus, Richard; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Powelson, John A.; Nagaraju, Santosh; Mihaylov, Plamen; Phillips, Carrie; Saxena, Romil; Goggins, William C.

In: American Journal of Nephrology, 14.07.2016, p. 85-91.

Research output: Contribution to journalArticle

Ekser, Burcin ; Mangus, Richard ; Kubal, Chandrashekhar A. ; Fridell, Jonathan A. ; Powelson, John A. ; Nagaraju, Santosh ; Mihaylov, Plamen ; Phillips, Carrie ; Saxena, Romil ; Goggins, William C. / Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria. In: American Journal of Nephrology. 2016 ; pp. 85-91.
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abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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.",
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T1 - Recurrence of Hyperoxaluria and Kidney Disease after Combined Intestine-Kidney Transplantation for Enteric Hyperoxaluria

AU - Ekser, Burcin

AU - Mangus, Richard

AU - Kubal, Chandrashekhar A.

AU - Fridell, Jonathan A.

AU - Powelson, John A.

AU - Nagaraju, Santosh

AU - Mihaylov, Plamen

AU - Phillips, Carrie

AU - Saxena, Romil

AU - Goggins, William C.

PY - 2016/7/14

Y1 - 2016/7/14

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AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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