{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:39Z","timestamp":1788667839519,"version":"build-2803163510"},"reference-count":15,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Calciphylaxis is a rare but life-threatening disorder characterised by progressive vascular calcification, thrombosis, and painful skin necrosis, with high morbidity and mortality. Although most cases are reported in patients with end-stage kidney disease receiving dialysis, it can also occur in kidney transplant recipients, particularly in the setting of chronic allograft dysfunction and persistent disturbances in mineral metabolism. We report the case of a 70-year-old man who developed biopsy-confirmed calciphylaxis during chronic allograft failure secondary to chronic T-cell-mediated rejection and BK virus nephropathy following deceased-donor kidney transplantation. Additional risk factors included hyperphosphataemia, secondary hyperparathyroidism, long-term warfarin therapy for a mechanical aortic valve, and ongoing immunosuppression. Management involved multidisciplinary care, including cessation of warfarin with bridging intravenous unfractionated heparin, initiation of maintenance haemodialysis, optimisation of chronic kidney disease-mineral and bone disorder, intravenous sodium thiosulfate administered after each haemodialysis session, intensive wound care, pain management, and planned hyperbaric oxygen therapy. Despite these interventions, the patient developed varicella-zoster virus encephalitis and disseminated\n                    <jats:italic toggle=\"yes\">Trichosporon<\/jats:italic>\n                    infection, resulting in progressive multisystem illness and death. This case highlights the multifactorial pathogenesis, diagnostic challenges, and poor prognosis of calciphylaxis in kidney transplant recipients with advanced allograft failure, particularly when anticoagulation cannot be safely discontinued because of a mechanical heart valve. Early recognition, histopathological confirmation, and prompt multidisciplinary management are essential; however, outcomes remain poor in patients with advanced graft dysfunction and ongoing immunosuppression.\n                  <\/jats:p>","DOI":"10.1177\/2050313x261479200","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T07:21:52Z","timestamp":1788506512000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe calciphylaxis in a post-kidney transplant patient with chronic allograft dysfunction and unmodifiable anticoagulation"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5546-4492","authenticated-orcid":false,"given":"Sivakajani","family":"Balakumar","sequence":"first","affiliation":[{"name":"Department of Nephrology, Royal Darwin Hospital, NT Health, NT, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelum","family":"Priyadarshana","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Royal Darwin Hospital, NT Health, NT, Australia"},{"name":"Northern Territory Medical Program, Flinders University, Darwin, NT, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandawana William","family":"Majoni","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Royal Darwin Hospital, NT Health, NT, Australia"},{"name":"Northern Territory Medical Program, Flinders University, Darwin, NT, Australia"},{"name":"Menzies School of Health Research, Charles Darwin University, NT, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","unstructured":"Massry SG Gordon A Coburn JW et al. Vascular calcification and peripheral necrosis in a renal transplant recipient. Am J Med 1970; 49(3): 416\u2013422. https:\/\/doi.org\/10.1016\/0002-9343(70)90085-X","DOI":"10.1016\/S0002-9343(70)80034-1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","unstructured":"Gipstein RM Coburn JW Adams DA et al. Calciphylaxis in man: a syndrome of tissue necrosis and vascular calcification in 11 patients with chronic renal failure. Arch Intern Med 1976; 136(11): 1273\u20131280. https:\/\/doi.org\/10.1001\/archinte.1976.03630110053016","DOI":"10.1001\/archinte.1976.03630110043012"},{"key":"e_1_3_3_4_2","doi-asserted-by":"crossref","unstructured":"Nigwekar SU Thadhani R Brandenburg VM. Calciphylaxis. N Engl J Med 2018; 378(18): 1704\u20131714. https:\/\/doi.org\/10.1056\/NEJMra1505292","DOI":"10.1056\/NEJMra1505292"},{"key":"e_1_3_3_5_2","doi-asserted-by":"crossref","unstructured":"Nigwekar SU Brunelli SM Meade D et al. Sodium thiosulfate therapy for calcific uremic arteriolopathy. Clin J Am Soc Nephrol 2013; 8(7): 1162\u20131170. https:\/\/doi.org\/10.2215\/CJN.09890912","DOI":"10.2215\/CJN.09880912"},{"key":"e_1_3_3_6_2","doi-asserted-by":"crossref","unstructured":"Hanvesakul R Silva MA Hejmadi RK et al. Calciphylaxis following kidney transplantation: a case report. J Med Case Rep 2009; 3: 9297. https:\/\/doi.org\/10.1186\/1752-1947-3-9297","DOI":"10.1186\/1752-1947-3-9297"},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","unstructured":"Brandenburg VM Kramann R Rothe H et al. Calcific uraemic arteriolopathy (calciphylaxis): data from a large nationwide registry. Nephrol Dial Transplant 2017; 32(1): 126\u2013132. https:\/\/doi.org\/10.1093\/ndt\/gfw087","DOI":"10.1093\/ndt\/gfv438"},{"key":"e_1_3_3_8_2","doi-asserted-by":"crossref","unstructured":"Welte T Schachtner T Reinke P. Successful management of calciphylaxis after kidney transplantation. Transplant Direct 2016; 2(4): 2\u20138. https:\/\/doi.org\/10.1097\/TXD.0000000000000605","DOI":"10.1097\/TXD.0000000000000582"},{"key":"e_1_3_3_9_2","doi-asserted-by":"crossref","unstructured":"Ryan MP Ross LS. Calciphylaxis after kidney transplant. Cureus 2019; 11(5): e4695. https:\/\/doi.org\/10.7759\/cureus.4695","DOI":"10.7759\/cureus.4695"},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","unstructured":"Srour N Alkhunaizi AM Alghonaim M et al. Non-uremic calciphylaxis in a post-renal transplant patient. Saudi J Kidney Dis Transpl 2019; 30(1): 215\u2013220. https:\/\/doi.org\/10.4103\/1319-2442.252913","DOI":"10.4103\/1319-2442.252913"},{"key":"e_1_3_3_11_2","doi-asserted-by":"crossref","unstructured":"Guill\u00e9n-Olmos MJ Aguilar-Garc\u00eda JA Rodr\u00edguez-Osorio L et al. Post-transplant calciphylaxis: a rare but devastating complication. Clin Kidney J 2022; 15(4): 611\u2013614. https:\/\/doi.org\/10.1093\/ckj\/sfab247","DOI":"10.1093\/ckj\/sfab205"},{"key":"e_1_3_3_12_2","doi-asserted-by":"crossref","unstructured":"Mitomo A Ishioka K Moriya H et al. A case of penile calciphylaxis development shortly after initiation of dialysis for graft dysfunction following living donor kidney transplantation: a case report. BMC Nephrol 2025; 26: 582. https:\/\/doi.org\/10.1186\/s12882-025-04511-7","DOI":"10.1186\/s12882-025-04511-7"},{"key":"e_1_3_3_13_2","doi-asserted-by":"crossref","unstructured":"Chang JJ El-Azhary RA Gibson LE et al. Calciphylaxis: diagnosis pathogenesis and treatment. Adv Skin Wound Care 2019; 32(5): 205\u2013215. https:\/\/doi.org\/10.1097\/01.ASW.0000554443.14002.13","DOI":"10.1097\/01.ASW.0000554443.14002.13"},{"key":"e_1_3_3_14_2","doi-asserted-by":"crossref","unstructured":"Brandenburg VM Evenepoel P Floege J et al. Lack of evidence clarity and consensus in the diagnosis and treatment of calciphylaxis. 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