Prolonged anuria complicating primary sclerosing cholangitis: successful outcome following orthotopic liver transplantation

A 49-year-old man with progressive obstructive jaundice secondary to primary sclerosing cholangitis developed acute, anuric renal failure requiring prolonged hemodialysis. Renal biopsy showed evidence of tubular epithelial toxicity, pigmented casts, interstitial fibrosis, and ischemic glomerular changes. After orthotopic liver transplantation (OLT), there was an immediate return of urine output. The introduction of tacrolimus (FK506) was delayed for 3 weeks after transplantation, during which time a gradual improvement in renal function occurred. Renal function remained stable 1 year later at a level of moderate impairment with good hepatic function.