Kidney Week

Abstract: TH-PO1036

Kidney Transplantation for Surgically Induced Enteric Oxalate Nephropathy: A Retrospective Multicenter Study

Session Information

• Transplantation: Clinical - Outcomes, Malignancy, and Pathology
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Wright, Matthew, Albany Med Health System, Albany, New York, United States

Matthew Wright, MBBS

• Chobanian, Michael C., Dartmouth Health, Lebanon, New Hampshire, United States

Michael C. Chobanian, MD

• Merzkani, Massini, Washington University in St Louis, St. Louis, Missouri, United States

Massini Merzkani, MD, MS

• Nazzal, Lama, New York University, New York, New York, United States

Lama Nazzal, MD, MS, MSc

• Tang, Jie, Brown University, Providence, Rhode Island, United States

Jie Tang, MD, MS, MPH, FASN

• Huang, Gaoyuan, University of Washington, Seattle, Washington, United States

Gaoyuan Huang, MD, MS

• Leca, Nicolae, University of Washington, Seattle, Washington, United States

Nicolae Leca, MD, FASN

• Wood, Kyle, University of Alabama at Birmingham Health System, Birmingham, Alabama, United States

Kyle Wood, MD

• Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States

Darshana M. Dadhania, MD, MS

• Leeds, Joseph T., University of Virginia, Charlottesville, Virginia, United States

Joseph T. Leeds, MD, FASN

• Leonardi, Nathaniel, University of Nebraska System, Lincoln, Nebraska, United States

Nathaniel Leonardi, DO

• Gauvin, Daniel Howard, University of California San Francisco, San Francisco, California, United States

Daniel Howard Gauvin, MD

• Breeggemann, Matthew Clarence, University of California San Francisco, San Francisco, California, United States

Matthew Clarence Breeggemann, MD

• Tandukar, Srijan, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Srijan Tandukar, MD

• Shah, Siddharth P., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Siddharth P. Shah, MD, FASN

• Hussain, Sabiha Malik, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Sabiha Malik Hussain, MD, FASN

• Basu, Arpita, Emory University, Atlanta, Georgia, United States

Arpita Basu, MD, MPH, FASN

• Azhar, Ambreen, Virginia Commonwealth University, Richmond, Virginia, United States

Ambreen Azhar, MBBS, MS

• Kandaswamy, Raja, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States

Raja Kandaswamy, MD, MBA

• Bunnapradist, Suphamai, University of California Los Angeles, Los Angeles, California, United States

Suphamai Bunnapradist, MD

• Lum, Erik Lawrence, University of California Los Angeles, Los Angeles, California, United States

Erik Lawrence Lum, MD, FASN

• Murakami, Naoka, Washington University in St Louis, St. Louis, Missouri, United States

Naoka Murakami, MD, PhD, FASN

• Matar, Abraham J., Dartmouth Health, Lebanon, New Hampshire, United States

Abraham J. Matar, MD

Background

Enteric hyperoxaluria from bariatric and other intestinal surgeries is an uncommon but increasingly recognized cause of oxalate nephropathy and end-stage kidney disease, yet transplant decision-making remains guided largely by small series and expert opinion. Data on recurrence risk, peri-transplant oxalate management, and long-term allograft outcomes in this heterogeneous population are particularly limited.

Methods

Adult kidney transplant recipients who developed enteric oxalate nephropathy as a complication of prior intestinal surgical procedures, thereby necessitating kidney transplantation, were identified from 16 centers across the United States. Long-term allograft outcomes, including graft survival and recurrence of oxalate nephropathy, were assessed.

Results

We identified 40 adult kidney transplant recipients with enteric oxalate nephropathy; 29 (72.5%) were female, 34 (85.0%) were Caucasian, and the median age at transplantation was 65 years. Bariatric and other intestinal surgical procedures were the predominant etiologies, with Roux-en-Y gastric bypass in 27 (67.5%) patients and a median interval of 13 years from causative surgery to kidney transplantation. Most recipients (34/40, 85.0%) were on dialysis pre-transplant, and 16 (40.0%) received living donor kidneys. Delayed graft function occurred in 15 (37.5%) patients, just over half of whom received dialysis prophylactically to mitigate oxalate burden. Overall patient survival at 1, 3, and 5 years was 97.3%, 90.2%, and 77.9%, respectively, with corresponding death-censored graft survival of 97.1%, 93.3%, and 93.3%. Among 38 recipients with follow-up, 11 (28.9%) developed recurrent oxalate-related kidney manifestations—most within 12 months post-transplant—and these were associated with a higher rate of death-censored graft failure (36.4% vs 7.4%). Pre-transplant calcium oxalate nephrolithiasis identified a higher-risk subgroup for post-transplant oxalate-related manifestations (47.4% vs 20.0%). 4 additional recipients without pre-transplant oxalate evaluation developed post-transplant oxalate-related injury after bariatric surgery, including one with graft failure.

Conclusion

In this multicenter series, kidney transplantation for surgically induced enteric oxalate nephropathy is feasible but frequently complicated by early recurrent oxalate deposition and an increased risk of graft failure in affected patients.

Acknowledgment

None