Combined Liver and Kidney Transplant for Primary Hyperoxaluria Type 2

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.