Primary hyperoxaluria type 2 (PH2) is a rare autosomal recessive disorder of oxalate overproduction that frequently leads to end-stage renal disease (ESRD). While isolated kidney transplantation is often performed, it carries a high risk of graft failure from recurrent oxalate nephropathy. We present the case of a 23-year-old female with PH2 and ESRD on maintenance hemodialysis who underwent combined liver-kidney transplantation (CLKT). Her postoperative course was complicated by delayed graft function, with serial biopsies revealing acute tubular injury and early oxalate crystal deposition. This was successfully managed with a short course of continuous renal replacement therapy to ensure aggressive oxalate clearance, leading to full recovery of graft function. This case highlights that while CLKT is a definitive treatment for severe PH2, its success is critically dependent on proactive, multidisciplinary intensive care to manage postoperative complications and prevent early graft loss from oxalate recurrence.
Misri et al. (2026) studied this question.