Calciphylaxis in simultaneous liver-kidney transplantation

Abstract

We present four patients who underwent simultaneous liver-kidney transplantation (SLK) and were diagnosed with calciphylaxis, also known as calcific uremic arteriolopathy (CUA). Common characteristics included high MELD scores (mean 35.2±4.8) and advanced renal disease (duration range 6-44 weeks). CUA was diagnosed within the first 2 months post-SLK based on clinical features. Severe morbidity and prolonged hospital stay were observed and one of the patients died secondary to sepsis. Treatment included metabolic support, wound care, calcium level correction and use of sodium thiosulphate. CUA should be considered in the presence of painful dermatologic changes in patients status post SLK. The authors report four cases of calciphylaxis (also known as calcific uremic arteriolopathy) that occurred early after simultaneous liver-kidney transplantation and discuss its high morbidity and mortality, clinical manifestations, risk factors, potential pathogenesis, prognosis, and treatment.