title: Disseminated Metastatic Tissue Calcification After Orthotopic Liver Transplantation: A Case Report.
abstract: BACKGROUND
  Hypercalcemia has been observed in patients after liver transplantation. However, it is rare that the hypercalcemia induced disseminated tissue calcification and heart failure.
  
  
  METHODS
  We report a rare case of heart failure caused by disseminated metastatic tissue calcification that involved extensive progressive myocardial calcification after liver transplantation. A 20-year-old man with end-stage liver disease due to biliary atresia underwent ABO-incompatible living donor liver transplantation. After successful transplantation, he suffered from antibody-mediated rejection. Subsequently, ABO-matched cadaveric liver retransplantation was successfully performed. Hypercalcemia developed gradually following the second transplantation. His serum calcium level increased to 18.3 mg/dL with sudden onset of ventricular tachycardia. Although he was resuscitated with a cardiopulmonary support device, he died of heart and liver failure. Histopathologic examination revealed systemic disseminated metastatic tissue calcification, including massive myocardial calcification.
  
  
  CONCLUSIONS
  Progressive worsening of hypercalcemia resulted in disseminated metastatic tissue calcification and massive metastatic myocardial calcification, which led to heart failure after liver transplantation. Because hypercalcemia after liver transplantation can cause fatal tissue calcification, early intervention for hypercalcemia should be considered.
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Deguchi
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan. Electronic address: ueno@pedsurg.med.osaka-u.ac.jp.
authors.forename: T
authors.initials: T
authors.lastname: Ueno
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Matsuura
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Yamanaka
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nara
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Uehara
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Tazuke
authors.affiliation: Department of Pediatrics, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Bessho
authors.affiliation: Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Okuyama
mesh_terms: D000328:Adult; D001656:Biliary Atresia / Q000150:complications; D001787:Blood Group Incompatibility / Q000150:complications; D002114:Calcinosis / Q000209:etiology*; D002118:Calcium / Q000097:blood; D009202:Cardiomyopathies / Q000209:etiology*; D017809:Fatal Outcome; D006084:Graft Rejection / Q000150:complications / Q000276:immunology / Q000601:surgery; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology*; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D017180:Tachycardia, Ventricular / Q000097:blood / Q000209:etiology
chemical_list: D002118:Calcium