PH1 Intensive Dialysis Oxalate Burden Pre-Transplant — ESENeph MCQ

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HardTubular DisordersPH1 Intensive Dialysis Oxalate Burden Pre-TransplantESENeph

A 47-year-old woman with primary oxalosis (PH1) has ESKD on intensive haemodialysis (6 days/week). Her plasma oxalate is 120 umol/L (markedly elevated). She is being assessed for combined liver-kidney transplant. Why is intensive dialysis required before transplantation?

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Correct answer: B — To reduce systemic oxalate burden and prevent oxalate deposition in the transplanted kidney

In PH1 with ESKD, the liver continues to overproduce oxalate but the kidneys can no longer excrete it. Plasma oxalate rises dramatically, leading to systemic oxalosis — calcium oxalate crystal deposition in the heart, bones, skin, eyes, and vascular system. Intensive dialysis (extended daily or daily nocturnal HD) reduces but cannot normalise the massive oxalate load. Before combined liver-kidney transplant, the systemic oxalate burden must be reduced as much as possible because post-transplant, stored tissue oxalate is mobilised and can damage the new kidney graft (oxalate nephropathy recurrence). High-volume haemodiafiltration or daily dialysis is continued post-liver-kidney transplant until plasma oxalate normalises.

Reference: Cochat & Rumsby 2013 – PH1 Management; Hoppe et al 2022 – PH1 Transplantation