Thrombotic Microangiopathy Associated With Tacrolimus in Lung Transplantation

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

doi:10.1016/j.arbr.2015.02.031

Cited by 7 publications

(8 citation statements)

References 5 publications

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“…In lung transplant, the estimated incidence is 2.3%, but only four case series and 11 cases have been reported [3,4,8]. Fifty percent of cases occurred during concurrent disease as in our report [3].…”

Section: Discussionmentioning

confidence: 70%

“…Fifty percent of cases occurred during concurrent disease as in our report [3]. In a recent review, a survival rate of 38.9% was described [3]; however, in the majority of case reports, TMA is associated with a favorable prognosis and managed with suspension or only dose reduction of CI [4,10,11]. In our case, tacrolimus was stopped, plasma exchange was started and intensified but still without success.…”

Section: Discussionmentioning

confidence: 75%

“…The calcineurin inhibitors (CI) are the mainstay of immunosuppression in lung transplant. Thrombotic microangiopathy (TMA) is a complication that has been increasingly reported in the recent years [3,4] and CI have been implicated in most cases [5]. We report a case of TMA in a lung transplant recipient receiving tacrolimus, with concomitant infection.…”

Section: Introductionmentioning

confidence: 99%

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Immunosuppressive Therapeutic Complications in a Lung Transplant Patient

et al. 2015

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The number of lung transplants has increased in the last years. Besides, the complications of immunosuppressive treatment, such as infections, have also been raising. Another complication, although seldom described, is thrombotic microangiopathy associated with calcineurin inhibitors. We report a case of a 65-year-old woman with a 6-month bi-pulmonary transplant, admitted for pneumonia. Addressing the differential diagnosis, pneumonia in immunosuppressed patient, aspergillosis, CMV disease and acute rejection were considered. High levels of tacrolimus were identified. The patient evolved with multiple organ dysfunctions. Hemodialysis was started on the third day. On the 5th day, patient developed progressive anemia, leukopenia and thrombocytopenia, schistocytes were present on peripheral smear and Coombs test was negative. A thrombotic microangiopathy probably related to tacrolimus high levels was identified. Plasma exchange was initiated on the eighth day, and intensified on the 11th day, without success, and on 14th day, the patient died. We believe our case report is relevant, since thrombotic microangiopathy in lung transplant has rarely been described and lung transplant is a growing reality, as well as its complications. Furthermore, our case is more severe than the ones described in literature, possibly due to prolonged tacrolimus toxic levels and concomitant infection.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Immunosuppressive Therapeutic Complications in a Lung Transplant Patient

et al. 2015

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“…However, given that discontinuation and re‐administration of tacrolimus was associated with the changes of the laboratory findings, tacrolimus is the most likely cause of TMA. In transplantation field, the treatment for TA‐TMA consists of discontinuing tacrolimus and switching to another calcineurin inhibitor (cyclosporine) or mTOR inhibitor (everolimus or sirolimus) for preventing rejection of the graft . Considering that a low incidence of TMA has also been reported with those drugs, they should be used very cautiously .…”

Section: Discussionmentioning

confidence: 99%

“…Although TA-TMA is rare, due to the recent increase in the number of organ transplants, TA-TMA has been increasingly reported in kidney, liver, and lung transplantations. [2][3][4] We report that a clinically asymptomatic TA-TMA in a rhesus monkey can be induced following pig-to-rhesus macaque corneal transplantation and that the timely diagnosis with laboratory tests accompanied by the anticoagulant treatment can save the recipient without graft rejection.…”

Section: Introductionmentioning

confidence: 98%

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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Tacrolimus

2015

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Thrombotic Microangiopathy Associated With Tacrolimus in Lung Transplantation

Cited by 7 publications

References 5 publications

Immunosuppressive Therapeutic Complications in a Lung Transplant Patient

Immunosuppressive Therapeutic Complications in a Lung Transplant Patient

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

Tacrolimus

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