Lumasiran, Isolated Kidney Transplantation, and Continued Vigilance

Patient 1, a girl with infantile oxalosis, was homozygous for c.731T→C (of unclear predicted pyridoxine sensitivity). She underwent intensive dialysis for 10 months before the initiation of lumasiran treatment, followed by 13 months of intensive dialysis plus lumasiran. At 3 years of age, she underwent isolated kidney transplantation from a deceased donor; the plasma oxalate level at the time of transplantation was 53 μmol per liter. The early postoperative period was marked by an obstruction of the ureteral stent as a result of oxalate crystallization, which led to transient acute kidney failure warranting hemodialysis from day 18 to day 36 after transplantation. In addition, one kidney stone on the graft was found at 1 month after transplantation and subsequently disappeared. At 18 months, a kidney biopsy was near normal, with very limited oxalate deposits. At the last follow-up, ultrasounds of the graft were also normal, without lithiasis or nephrocalcinosis, and kidney function was normal.


AUTORE: Justine Bacchetta, Stéphanie Clavé, Lisa J. Deesker, et al.