Figure 1714

Daily hemodialysis for at least 1 week before transplantation depletes the systemic oxalate pool to some extent. Some centers continue aggressive hemodialysis after transplantation, regardless of the renal function of the transplanted organ. In patients receiving combined hepatorenal grafts, dietary measures to reduce oxalate production are not as important as they are in patients receiving isolated kidney grafts. In these patients, excess production of oxalate from glyoxylate still occurs. Magnesium and phosphate supplements are powerful inhibitors of calcium oxalate crystallization and should be used in all recipients, whereas thiazide diuretics may reduce urinary calcium excretion. Pyridoxine is a cofactor for alanine-glyoxylate aminotransferase and can increase the activity of the enzyme in some patients. Pyridoxine has no role in combined hepatorenal transplantation. For most patients the ideal option is probably a combined transplantation when their glomerular filtration rate decreases below 25 mL/min [8,9].

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