V HERON1,2, P KERR2, J KANELLIS2, K POLKINGHORNE2, N ISBEL3, E SEE2
1Renal Service, Darling Downs Hospital And Health Service, Toowoomba, Australia, 2Department of Nephrology, Monash Health, Clayton, Australia, 3Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
Aim: To evaluate graft and patient outcomes following kidney transplantation in end stage kidney disease (ESKD) secondary to hyperoxaluria using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.
Background: Hyperoxaluria has presented a challenge for transplant physicians given the risk of disease recurrence in the graft. There has been no analysis of transplant and patient outcomes using the ANZDATA registry.
Methods: This cohort study compared the outcomes of all patients with ESKD secondary to hyperoxaluria who received a kidney transplant in Australia and New Zealand between 1965 and 2015 to propensity score matched controls with ESKD secondary to reflux nephropathy. The primary outcome measure was graft survival. Secondary outcomes included estimated glomerular filtration rate (eGFR), acute rejection and patient survival.
Results: Nineteen kidney transplants were performed in 16 patients with hyperoxaluria between September 1965 and December 2015. Median graft survival was 1.8 years (IQR 0.4–10.6) in hyperoxaluria recipients compared to 6.8 years (IQR 2.7–13.0) in reflux nephropathy controls. Compared to reflux nephropathy, hyperoxaluria was not associated with an increased risk of graft failure (SHR 2.43, 95% CI 0.94—6.22, p=0.07). The most common cause of graft failure in the hyperoxaluria cohort was recurrent disease in contrast to chronic allograft nephropathy for reflux nephropathy recipients. Hyperoxaluria was associated with a higher post-transplant serum creatinine, but not with an increased risk of acute rejection or death.
Conclusion: Compared to reflux nephropathy, ESKD secondary to hyperoxaluria was not associated with inferior graft survival, patient survival, or acute rejection risk. However, post-transplant serum creatinine was higher and there was a shorter time to graft failure.
Vanessa Heron is an advanced trainee in nephrology currently working at Toowoomba Hospital, Queensland.