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Open Access Case report

Graft calcifications and dysfunction following liver transplantation

George N Tzimas1, Mohammad Afshar2, Eric Chevet3, Anouk Emadali13, Hojatollah Vali2 and Peter P Metrakos1*

Author Affiliations

1 Division of General Surgery/ Section of Hepatobiliary and Transplantation Surgery, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, S 10.26, Montreal, Quebec, H3A 1A1, Canada

2 Facility for Electron Microscopy Research, Strathcona Medical Building, 3640 University Street, McGill University, Montreal, Quebec, H3A 2B2, Canada

3 Organelle Signaling Laboratory, Department of Surgery, Royal Victoria Hospital, H 6.34, McGill University, 687 Pine Avenue West, Montreal, Quebec, H3A 1A1, Canada

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BMC Surgery 2004, 4:9  doi:10.1186/1471-2482-4-9

Published: 3 September 2004

Abstract

Background

The molecular events, following ischemia and reperfusion (I/R) of the liver during transplantation are largely unknown. There is evidence that apoptotic and necrotic events may take place, and occasionally result in primary graft dysfunction. We herein report two cases, where significant I/R injury correlated with the development of liver calcification and primary liver dysfunction.

Case Presentation

Both patients with clinical and biochemical evidence of primary graft dysfunction demonstrated calcification at light and electron microscopy levels. In addition, one patient had macroscopic evidence of calcification on cross-sectional imaging. Both patients died secondary to the sequelae of the graft dysfunction.

Conclusions

Severe I/R-induced injury to the liver, clinically leads to graft dysfunction. This is due to advanced apoptotic and/or necrotic events at the hepatocyte level that may, on the most severe form, lead to calcification. The study of microcalcification at the early posttransplant period could provide insight in the events taking place following significant ischemia/reperfusion-induced injury to the graft.

Keywords:
Liver Transplantation; Ischemia; Reperfusion; Graft Dysfunction; Outcome