Microangiopatía trombótica asociada a tacrolimus en trasplante pulmonar

Mezquida, Juan Pablo Reig; Jover, A; Barrera, Emilio Ansótegui; Peiró, Juan Escrivá; Colom, Maria Desamparados Pastor; Guillem, J. Pastor

doi:10.1016/j.arbres.2014.07.004

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…Treatment recommendations for TMA have changed in recent years. Besides plasma exchange, eculizumab is now recommended in specific cases, but in transplant-associated and drug-induced TMA, the primary treatment is still immunosuppression change [1,3,4,8]. In a small study of 7 patients who underwent organ transplantations (5 small bowel and 2 liver) complicated by TMA, eculizumab was used after treatment failure with CNI reduction, withdrawal, and plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: A Case Report

Menezes

Aires

Semedo

et al. 2019

Transplantation Proceedings

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Thrombotic microangiopathy (TMA) is a pathologic condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury due to microvascular endothelial lesions and thrombosis. It occurs in a variety of diseases and, unless recognized and treated, leads to severe morbidity and mortality. We present the case of a 48-year-old woman who underwent lung transplantation, initially under tacrolimus, mycophenolate mofetil (MMF), and prednisolone. Several complications emerged in the following months, including abdominal aortic and left renal artery thrombosis and cutaneous infections, although her renal function remained normal. Six months after transplant, her renal function began to deteriorate, which was assumed to be due to elevated tacrolimus levels and doses were adjusted. Due to leukopenia, MMF was changed to everolimus. One year after, she was admitted with fatigue, anemia, and renal dysfunction. Complementary exams revealed only iron deficiency, leukopenia, normal platelets, and elevated lactate dehydrogenase; her renal ultrasound was normal. A renal biopsy was performed and thrombotic microangiopathy was subsequently identified as the main cause of the renal dysfunction. Tacrolimus was therefore discontinued and MMF restarted with slow improvement of renal function. Only when everolimus was stopped did the patient's renal function show incremental improvement. TMA may be a serious complication after lung transplantation and the risk is higher when a combination of tacrolimus and everolimus is used. Renal biopsy findings are essential to confirm the final diagnosis of TMA, allowing for a change in immunosuppression to prevent permanent and severe renal damage.

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Section: Discussionmentioning

confidence: 99%

An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: A Case Report

Menezes

Aires

Semedo

et al. 2019

Transplantation Proceedings

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“…Most of the cases are reported during the year following transplantation [4]. For half of the cases, TMA is associated with a concurrent disease, mainly infection [4, 5]. The use of antibiotics, especially those who interact with calcineurin inhibitors (CNI), also contributes to TMA pathogenesis [4, 6].…”

Section: Introductionmentioning

confidence: 99%

“…The use of antibiotics, especially those who interact with calcineurin inhibitors (CNI), also contributes to TMA pathogenesis [4, 6]. In addition, immunosuppressive therapy plays a key role [5]. The association of mammalian target of rapamycin inhibitors (mTORi) and CNI as immunosuppressive regimen appears to be the strongest risk factor for TMA after lung transplantation [4, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

An Atypical Case of Shiga Toxin Producing-Escherichia Coli Hemolytic and Uremic Syndrome (STEC-HUS) in a Lung Transplant Recipient

Manière

Domenger

Camara³

et al. 2019

Case Reports in Transplantation

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We herein describe the first case of thrombotic microangiopathy (TMA) which was related to Shiga toxin producing-Escherichia Coli Hemolytic and Uremic Syndrome (STEC-HUS) after lung transplantation. His maintenance immunosuppression relied on tacrolimus plus mycophenolic acid. TMA was treated with plasma exchanges (PE) (fresh frozen plasma substitution). After five days of PE, platelets count and lactate dehydrogenase level normalized, whereas hemoglobin continued to gradually decrease and no improvement in kidney function was observed. After seven PE sessions, all TMA biological signs resolved. However, kidney function did not improve, and the patient still required chronic dialysis.

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Tacrolimus‐induced asymptomatic thrombotic microangiopathy diagnosed by laboratory tests in pig‐to‐rhesus corneal xenotransplantation: A case report

Kim¹,

Kim

Choi

et al. 2018

Xenotransplantation

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Tacrolimus-associated thrombotic microangiopathy (TA-TMA) is a rare complication. TA-TMA is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ damage due to thrombus. We report asymptomatic TA-TMA diagnosed by laboratory tests in pig-to-rhesus corneal xenotransplantation. Corneal transplantation had been conducted from a wild-type SNU miniature pig to a rhesus macaque. The veterinary records were retrospectively reviewed in this case. The immunosuppressive regimen consisted of rituximab, basiliximab, and IVIg as inductive therapies, and steroids with tacrolimus (0.1 mg/kg/day) as maintenance therapies. Although there were no clinical symptoms, increased levels of lactate dehydrogenase, total bilirubin, blood urea nitrogen, and creatinine and decreased levels of hemoglobin and platelet were observed in laboratory tests on Day (D) 61. Systemic TA-TMA was tentatively diagnosed. Tacrolimus was discontinued starting on D71. Dalteparin, clopidogrel bisulfate (D77-D99), and IVIg (D72) were administered as a conservative treatment. Abnormal laboratory results were reversed on D99. When low-dose tacrolimus (0.07 mg/kg/day) was re-administered on D131 to prevent rejection of the graft, TMA was detected again by laboratory tests on D161, confirming the initial diagnosis. Discontinuation of tacrolimus on D162 and re-administration of Dalteparin (D161-D196) corrected the laboratory values on D161. This report shows that in pig-to-rhesus corneal xenotransplantation, clinically asymptomatic TMA can be induced by tacrolimus, and the discontinuation of tacrolimus and administration of anticoagulant seems sufficient to correct the laboratory TMA.

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Microangiopatía trombótica asociada a tacrolimus en trasplante pulmonar

Cited by 6 publications

References 5 publications

An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: A Case Report

An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: A Case Report

An Atypical Case of Shiga Toxin Producing-Escherichia Coli Hemolytic and Uremic Syndrome (STEC-HUS) in a Lung Transplant Recipient

Tacrolimus‐induced asymptomatic thrombotic microangiopathy diagnosed by laboratory tests in pig‐to‐rhesus corneal xenotransplantation: A case report

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