Deguchi K, Ueno T, Matsuura R, Yamanaka H, Nara K, Uehara S, Tazuke Y, Bessho K, Okuyama H
Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
Department of Pediatric Surgery, Osaka University, Postgraduate School of Medicine, Osaka, Japan.
Transplant Proc. 2016 Jan-Feb;48(1):251-4. doi: 10.1016/j.transproceed.2015.12.033.
Hypercalcemia has been observed in patients after liver transplantation. However, it is rare that the hypercalcemia induced disseminated tissue calcification and heart failure.
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.
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.
肝移植术后患者中曾观察到高钙血症。然而，由高钙血症导致弥漫性组织钙化和心力衰竭的情况较为罕见。
我们报告一例罕见的因弥漫性转移性组织钙化导致心力衰竭的病例，该病例在肝移植后出现广泛进展性心肌钙化。一名因胆道闭锁导致终末期肝病的20岁男性接受了ABO血型不相容的活体供肝肝移植。移植成功后，他发生了抗体介导的排斥反应。随后，成功进行了ABO血型匹配的尸体肝再次移植。第二次移植后高钙血症逐渐出现。他的血清钙水平升至18.3mg/dL，并突然发生室性心动过速。尽管使用心肺支持设备使其复苏，但他最终死于心、肝衰竭。组织病理学检查显示全身弥漫性转移性组织钙化，包括大量心肌钙化。
高钙血症的进行性加重导致弥漫性转移性组织钙化和大量转移性心肌钙化，进而在肝移植后导致心力衰竭。由于肝移植后的高钙血症可导致致命的组织钙化，因此应考虑对高钙血症进行早期干预。
