Abstract: TH-PO852
Calciphylaxis in Kidney Transplantation Recipients
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Stoy, David Joseph, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Singh, Tripti, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Gardezi, Ali I., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Aziz, Fahad, University of Wisconsin-Madison, Madison, Wisconsin, United States
Background
Calciphylaxis, also called calcific uremic arteriolopathy (CUA), is a rare vascular disorder of subcutaneous microcirculation calcification and thrombosis. CUA results in painful non-healing necrotic ulcers and often portends poor outcomes. Minimal data exist describing post-kidney transplant calciphylaxis's incidence, management, and long-term outcomes. Herein we describe a series of calciphylaxis in kidney transplant recipients.
Methods
Single-center observational cohort study of patients who received kidney transplantation (KT) between 1/1/1994 and 1/1/2023 and who developed calciphylaxis at any time after transplant with a functional kidney allograft.
Results
During the 29-year study period, nine patients had biopsy-proven calciphylaxis (CUA). Six patients had kidney transplant (KT) alone, two had a simultaneous pancreas and KT, and one had simultaneous liver and KT. None of the patients had a preemptive KT; only one received a living donor transplant. The mean age at the time of KT was 41 ± 13.4 years, and the mean at the time of calciphylaxis diagnosis was 45 ± 16.5 years. All patients received lymphocyte-depleting induction (anti-thymocyte globulin) at the time of transplant. The mean duration on dialysis before KT was 3.4 ± 2. The mean time from transplant to the diagnosis of CUA was 4 ± 6.4 years); six patients developed CUA within twelve months of KT. Only one patient had a history of calciphylaxis before the transplant. At the time of CUA diagnosis, the mean eGFR was 57 ± 23 mL/min/1.73 m2; the mean for calcium was 10 ± 0.7, phosphorous was 3.6 ± 1, and iPTH was 212 ± 284 pg/ml. Location of CUA was distal lower extremity in seven patients. Eight patients required debridement, and four patients received sodium thiosulphate. Six patients were concurrently on anticoagulation at time of CUA diagnosis. Before 2001, three of four patients recieved parathyroidectomy. After 2001, one of five patients had parathyroidectomy. The mean follow up after the calciphylaxis diagnosis was 3 ± 3.2 years. At the last follow-up, three patients lost their kidney allograft, and four died.
Conclusion
Post-transplant calciphylaxis is rare and associated with high mortality and allograft loss. More extensive studies are needed to examine this condition's risk factors and management.