Abstract: SA-PO1201
Intensive Hemodialysis to Treat Post-Transplant Oxalate Nephropathy
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Nanavati, Alay Parul, Brown University, Providence, Rhode Island, United States
- Dailey, Jennifer, Brown University, Providence, Rhode Island, United States
- Patel, Pooja V., Brown University, Providence, Rhode Island, United States
- Merhi, Basma Omar, Brown University, Providence, Rhode Island, United States
Introduction
High plasma oxalate levels after kidney transplantation are associated with poor graft outcomes. We report a case of acute post-transplant oxalate nephropathy, 10 years after a Roux-en-Y gastric bypass (RYGP), successfully treated with intensive hemodialysis (HD).
Case Description
A 58-year-old female with end stage renal disease presumed from diabetes on HD for 8 years and a RYGP 10 years ago received a deceased donor kidney transplant. Suboptimal allograft function with a serum creatinine (sCr) of 3 mg/dL at 1 month post-transplant led to an allograft biopsy revealing intratubular calcium oxalate crystals with mild interstitial inflammation (Fig 1A, B). 24-hour urine collection showed hypocitraturia and normoxaluria. Despite starting potassium citrate, calcium carbonate, and a low oxalate diet, allograft function worsened (sCr of 5.3 mg/dL). Allograft biopsy showed greater crystal burden (Fig 1C, D). Intensive 4-hours daily HD over 5 consecutive days was initiated. Plasma oxalate levels (POx) peaked prior to initiating HD at 48 µmol/L (normal < 2µmol/L). At 3 months post-transplant, her POx level normalized with improved allograft function (sCr 2.7 mg/dL) and reduced crystal burden on allograft biopsy (Fig 1E, F).
Discussion
This case highlights intensive HD as a crucial effective therapeutic strategy to rapidly reduce systemic oxalate burden. It underscores the need for pre-transplant monitoring of POx levels in high-risk patients prior to transplant and establishing preventive strategies.