Tacrolimus-induced hemolytic uremic syndrome and end-stage renal failure after liver transplantation.
BACKGROUND
Hemolytic uremic syndrome (HUS) is a rare complication in solid organ transplantation. It can be associated with severe hypertension. Several risk factors have been identified including immunosuppressive drugs such as cyclosporin A and, more recently, tacrolimus.


METHODS
Here we report a case of tacrolimus-induced HUS in a 61-yr-old woman after liver transplantation. Hypertension, microangiopathic anemia and end-stage renal failure occurred 2 yr after liver transplantation.


RESULTS
At admission, she had malignant hypertension with a severe hypertensive retinopathy, renal failure (creatininemia: 800 micromol/L) and microangiopathic anemia (Hb: 7.3 g/dL, a low platelet count and elevated lactate dehydrogenase). At renal biopsy, histologic findings were ischemic and sclerotic glomeruli with hyaline thrombi, severe mesangiolysis and interstitial fibrosis.


CONCLUSIONS
Despite steroid treatment, antihypertensive agents and fresh frozen plasma therapy, end-stage renal failure was observed and chronic hemodialysis treatment was required.
Rerolle
J P
JP
Service de Néphrologie A, Hôpital Tenon, Paris, France.
Akposso
K
K
Lerolle
N
N
Mougenot
B
B
Ponnelle
T
T
Rondeau
E
E
Sraer
J D
JD
D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000473:pathology; D016031:Liver Transplantation; D008875:Middle Aged; D016559:Tacrolimus / Q000009:adverse effects*
D007166:Immunosuppressive Agents; D016559:Tacrolimus