Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. May 28, 2025; 17(5): 105785
Published online May 28, 2025. doi: 10.4329/wjr.v17.i5.105785
Calciphylaxis following liver transplantation in a patient with end-stage renal disease: A case report
Xiang-Ling Wei, You-Wen Zhang, Ming Han, Cheng-Jun Sun, Guan-Zhi Lai, Shui-Guo Tang, Rong-Ji Ye, Hao-Qing Xu, Lin-Wei Wu, Wu-Zheng Xia
Xiang-Ling Wei, Ming Han, Cheng-Jun Sun, Guan-Zhi Lai, Shui-Guo Tang, Rong-Ji Ye, Hao-Qing Xu, Lin-Wei Wu, Wu-Zheng Xia, Department of Organ Transplantation, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
You-Wen Zhang, Department of Radiology, Youxian People's Hospital, Zhuzhou 412300, Hunan Province, China
Wu-Zheng Xia, Department of General Surgery, Guangdong Provincial People's Hospital Ganzhou Hospital, Ganzhou 341099, Jiangxi Province, China
Co-first authors: Xiang-Ling Wei and You-Wen Zhang.
Co-corresponding authors: Lin-Wei Wu and Wu-Zheng Xia.
Author contributions: Wei XL and Zhang YW contributed equally to this work, and they drafted the manuscript and designed the study; Han M, Sun CJ, Lai GZ, and Tang SG collected the data; Ye RJ and Xu HQ revised the manuscript. Wu LW and Xia WZ played critical and complementary roles in the conceptualization, data interpretation, and manuscript preparation as co-corresponding authors. Wu LW conceptualized the case report, provided overall supervision throughout the study, was responsible for the literature search, and revised the early version of the manuscript. Xia WZ contributed significantly to the data analysis, re-interpretation of clinical findings, and figure preparation, and revised and submitted the current version of the manuscript. The collaboration between Wu LW and Xia WZ was essential for the successful completion and submission of this case report. All authors approved the final manuscript.
Supported by the Guangzhou Basic and Applied Basic Research Foundation, No. 2025A04J4730; National Natural Science Foundation of China, No. 82470635 and No. 82300751; Guangdong Basic and Applied Basic Research Foundation, No. 2024A1515011723; Medical Scientific Research Foundation of Guangdong Province of China, No. A2023033; and Jiangxi Provincial Natural Science Foundation, No. 20244BAB28028.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wu-Zheng Xia, PhD, Department of Organ Transplantation & Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial People's Hospital Ganzhou Hospital, No. 49 Dagong Road, Ganzhou 341099, Jiangxi Province, China. xiawuzheng@gdph.org.cn
Received: February 7, 2025
Revised: March 29, 2025
Accepted: May 7, 2025
Published online: May 28, 2025
Processing time: 108 Days and 18.5 Hours
Abstract
BACKGROUND

Calciphylaxis, also called calcific uremic arteriolopathy, is characterized by microvascular calcification and occlusion, which is commonly seen in patients with end-stage renal disease (ESRD). Although several studies have demonstrated an association of calciphylaxis with ESRD, reports linking calciphylaxis to LT (LT) are scarce. This report presents a rare case of calciphylaxis in a patient who underwent LT, leading to microvascular occlusion and hyperbilirubinemia.

CASE SUMMARY

A 34-year-old man presented with a 7-day history of jaundice and severe bilateral leg pain. The patient had undergone LT and was put on hemodialysis for one year due to calcineurin inhibitor-induced ESRD. Physical examination revealed jaundice, leathery skin changes, severe muscle pain in both legs, and penile induration. Laboratory tests identified elevated bilirubin levels, gamma-glutamyltransferase, and alkaline phosphatase, while alanine aminotransferase and aspartate aminotransferase concentrations were within normal limits. Computed tomography (CT) revealed extensive calcifications in the subcutaneous tissue. Three-dimensional CT reconstruction indicated significantly reduced blood flow in the hepatic artery, primarily in the small to medium-sized branches. Contrast-enhanced ultrasonography confirmed hepatic ischemia, with no enhancement seen in hepatic artery branches. Liver biopsy specimen revealed no signs of rejection. The patient decided to receive conservative treatment and succumbed to the illness after six months.

CONCLUSION

This case indicates that calciphylaxis should be suspected in patients who have undergone LT with ESRD presenting with hyperbilirubinemia and skin lesions.

Keywords: Calciphylaxis; Hyperbilirubinemia; Calcification; Liver transplantation; End-stage renal disease; Case report

Core Tip: Calciphylaxis, a rare and life-threatening syndrome characterized by vascular calcification and tissue necrosis, predominantly affects end-stage renal disease patients. This case demonstrates the occurrence of calciphylaxis in a liver transplant recipient, presenting with multi-organ calcifications and hyperbilirubinemia caused by hepatic artery calcification. Early recognition of cutaneous and systemic calcification, combined with the management of metabolic dysregulation, is critical. This report indicates that calciphylaxis may be an unneglectable differential diagnosis for hyperbilirubinemia in transplant recipients and advocates for the development of preventive strategies in high-risk populations.