Successful Management of Calciphylaxis in a Kidney Transplant Patient

Abstract

IntroductionCalciphylaxis 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 descriptionA 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.DiscussionWe 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.

The use of cinacalcet for the treatment of calciphylaxis in patients with chronic kidney disease: A comprehensive review

“…This has lead to the trial of alternative, less invasive options including oxygen therapy, corticosteroids (for non‐ulcerating lesions at low risk for infection), sodium thiosulfate and cinacalcet. Although some of these noninvasive therapies have meant some patients have avoided parathyroidectomy, there is limited evidence for their efficacy or recurrence rates for calciphylaxis (Table ) …”

Gastric Pneumatosis from Isolated Gastric Calciphylaxis

“…Proposed methods of preventing calciphylaxis include managing comorbid conditions, such as diabetes mellitus, chronic kidney disease, and obesity, as well as decreasing calcium supplements and using non-calcium-based renal supplements 6,7. Previous case reports cite the resolution of cutaneous calciphylaxis after kidney transplantation 8,9. On the basis of the existing literature, this unfortunate complication of hemodialysis may have been prevented by a kidney transplant.…”

Calciphylaxis in end‐stage liver and renal disease patients before and after transplant

“…Nordheim et al further suggested that normal kidney graft function was imperative for cure after transplantation. Despite this, a case of calciphylaxis occurring after kidney transplant in a patient with normal graft function has also been reported, and predictive factors for the development and/or resolution of this disorder have yet to be identified …”

“…Reports exist of patients being cured of calciphylaxis after kidney transplantation . Conversely, there are case reports of patients developing calciphylaxis after kidney transplant as well as simultaneous liver‐kidney (SLK) transplant . We review calciphylaxis and summarize the published experience of the relationship between calciphylaxis and liver, kidney, and SLK transplantation.…”

“…and 2 shows background data, treatments, and outcomes for kidney transplant patients who developed calciphylaxis in the pre-or post-transplant period 1,2,5,6,13,[19][20][21][22][23][24][25][26][27][29][30][31] 71.4% of patients had ESRD and 85.7% had ESRD or chronic kidney disease (CKD) at the time of calciphylaxis onset.…”