Successful Management of Calciphylaxis in a Kidney Transplant Patient: Case Report. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Welte, Thomas; Arnold, Frederic; Technau-Hafsi, Kristin; Neumann-Haefelin, Elke; Wobser, Rika; Zschiedrich, Stefan; Walz, Gerd; Kramer-Zucker, Albrecht
• Is Part Of: Transplantation direct. Volume 2:Issue 4(2016)
• Publication Date: 2016-04
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation -- Periodicals; 362.19795
• DOI: 10.1097/TXD.0000000000000582
• Languages: English
• ISSNs: 2373-8731

Abstract

Abstract : Introduction: Calciphylaxis is a rare and often fatal condition mostly associated with end-stage renal disease. The pathophysiology remains elusive and treatment options are scarce. We present a rare case of severe calciphylaxis after kidney transplantation in a patient with persistent hyperparathyroidism. Case description: A 78-year-old man with a history of end-stage renal disease developed edema and ulcerations on both lower limbs 14 months after kidney transplantation while receiving an mammalian target of rapamycin inhibitor to manage polyoma virus-associated nephropathy. Skin biopsies taken from the ulcerations confirmed calciphylaxis. A multimodal treatment regimen combining medical (calcium-free phosphate binders, cinacalcet, paricalcitol, sodium thiosulfate, antibiotic treatment) and surgical treatments (debridement and autologous skin transplantation) ultimately resulted in successful wound healing. Discussion: We describe a case of severe calciphylaxis in a nonuremic patient after kidney transplantation. Rapid diagnosis by skin biopsy and an aggressive multimodal therapy regimen followed by long-term oral sodium thiosulfate treatment were crucial factors for a favorable outcome.