title: Calciphylaxis-associated second renal graft failure and patient loss: a case report and review of the literature.
abstract: OBJECTIVE
  Calciphylaxis is a small vessel disease that affects 1% to 4% of patients undergoing dialysis. Only 21 cases of postrenal transplant calciphylaxis have been reported, but none has been associated with primary graft failure or has occurred in a second graft. We present the first case of second renal graft calciphylaxis leading to primary graft failure and death.
  
  
  METHODS
  We reviewed the 22 cases, including ours, and assessed risk factors, management, and mortality for these cases.
  
  
  RESULTS
  The mean age was 34.2 -/+ 10.6 years, 11 patients were males (50%), and 13 (57.9%) underwent a deceased-donor renal transplant. The mean pretransplant dialysis period was 35.7 -/+ 39.3 months, 22 patients (100%) were on steroid therapy, 8 (36.4%) had a rejection, 18 (81.8%) underwent postcalciphylaxis parathyroidectomy, and 11 patients died (50%). Acute graft rejection and its management in the presence of high parathormone and divalent ion levels may be associated with postrenal transplant calciphylaxis.
  
  
  CONCLUSIONS
  If the high parathormone levels are not adequately suppressed with medical treatment, prerenal transplant preparation should include parathyroidectomy. In addition, steroids and other immunosuppressive medications should be tapered quickly in calciphylaxis patients, especially if a patient's life is at risk.
authors.affiliation: King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Gamal
authors.initials: G
authors.lastname: Aabed
authors.forename: Othman
authors.initials: O
authors.lastname: Al Furayh
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Lehbi
authors.forename: Hadeel
authors.initials: H
authors.lastname: Al Mana
authors.forename: Abdulla
authors.initials: A
authors.lastname: Al Ghamedi
authors.forename: Ahmed
authors.initials: A
authors.lastname: Helmy