A Case of Successful Kidney Transplant-Alone in Primary Hyperoxaluria Type 1 Using Lumasiran

Simultaneous liver-kidney transplantation (SLKT) has been the standard of care for patients with end-stage renal disease (ESRD) and primary hyperoxaluria type 1 (PH1). Lumasiran is a novel RNA interference (RNAi) therapy that targets glycolate oxidase and decreases oxalate production in the liver. Despite its availability, the use of RNAi with kidney transplant alone (KTA) for ESRD related to primary hyperoxaluria remains limited. We report a 39-year-old female with a history of KTA who presented with diarrhea and severe AKI. She rapidly progressed to anuria and allograft loss. Her kidney biopsy demonstrated calcium oxalate deposition. The patient was subsequently evaluated for a repeat kidney transplant. Given the morbidity associated with SLKT, RNAi therapy was pursued as an alternative. Initiation of Lumasiran reduced serum oxalate from 40 to 8 µmol/L, enabling successful KTA with immediate graft function. At 12 months post-transplant, renal function remained stable (creatinine 0.82 mg/dL, serum oxalate <1.5 µmol/L). This case highlights RNAi therapy as a promising strategy to facilitate KTA in patients with PH1 and ESRD, potentially reducing the need for SLKT and its associated morbidity.