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      Oxalate Kinetics and Reversal of the Complications after Orthotopic Liver Transplantation in a Patient with Primary Hyperoxalosis Type 1 Awaiting Renal Transplantation

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          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 maintenance hemodialysis, and despite intensification of the dialytic treatment, developed severe livedo reticularis in her extremities leading to ischemic cutaneous ulcerations, necessitating continuous intravenous infusion of narcotics for pain control. She received a liver transplant after native hepatectomy. However, due to positive crossmatch, she could not receive a kidney from that donor. After transplantation, following serial serum oxalate levels, 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 resolved. Our results suggest that in patients with primary hyperoxaluria type 1, who have received a liver transplant and are on maintenance hemodialysis, after serial serum oxalate determinations, some may safely be changed to a thrice-weekly maintenance hemodialysis regimen. Moreover, with this regimen the complications of systemic oxalosis can reverse.

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          Author and article information

          Am J Nephrol
          American Journal of Nephrology
          S. Karger AG
          February 1999
          22 March 1999
          : 19
          : 1
          : 64-69
          Divisions of aNephrology, bAbdominal Organ Transplantation, and cDermatology, St. Louis University Health Sciences Center, St. Louis, Mo., USA
          13428 Am J Nephrol 1999;19:64–69
          © 1999 S. Karger AG, Basel

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          Figures: 3, References: 22, Pages: 6
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