[Homozygote deficiency of thiopurine methyltransferase. A contraindication to the use of azathioprine in kidney transplantation].
Azathioprine-induced myelosuppression is the most important side effect observed in kidney transplantation. We report a case of severe neutropenia after kidney transplantation due to a thiopurine methyltransferase deficiency. This cause of azathioprine-induced myelotoxicity is rare, but its infectious consequences may be severe. Thiopurine methyltransferase deficiency must therefore be suspected when early and severe leukopenia occurs during azathioprine therapy. Erythrocyte thiopurine methyltransferase activity measurement confirms the diagnosis. Azathioprine and 6-mercaptopurine must afterwards be definitively avoided.
Frappier
J
J
Service de Transplantation et Réanimation, INSERM U75, Paris.
Legendre
C
C
Soria-Royer
C
C
Barbanel
C
C
Kreis
H
H
Beaune
P
P
D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D000075202:Contraindications; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications / Q000601:surgery; D006084:Graft Rejection / Q000517:prevention & control*; D006720:Homozygote; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D007970:Leukopenia / Q000139:chemically induced*; D015122:Mercaptopurine / Q000009:adverse effects / Q000627:therapeutic use; D008780:Methyltransferases / Q000172:deficiency* / Q000235:genetics; D008875:Middle Aged; D011183:Postoperative Complications; D014184:Transplantation, Homologous
D015122:Mercaptopurine; D008780:Methyltransferases; C022745:thiopurine methyltransferase; D001379:Azathioprine