Clopidogrel-associated thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in a kidney/pancreas transplant recipient.
BACKGROUND
We present a case report of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS) developing in a kidney/pancreas transplant recipient after the initiation of treatment with clopidogrel for symptomatic coronary artery disease.


METHODS
A 35-year-old male kidney/pancreas recipient developed unstable angina 5 years after transplantation. The patient was treated with clopidogrel as adjunct therapy. A TTP/HUS condition developed, was diagnosed early, and successfully reversed with the implementation of plasmapheresis and cessation of clopidogrel and cyclosporine A.


RESULTS
The patient continues taking cyclosporine A with good renal function 6 months after the incident, and successfully underwent coronary artery by-pass grafting 3 months after the event.


CONCLUSIONS
This case demonstrates that early identification and treatment can reverse the TTP/HUS process associated with thienopyridine-derived agents. We strongly recommend that drugs of the thienopyridine class be used cautiously in transplant recipients, especially those taking calcineurin-inhibitors.
Chinnakotla
S
S
Department of Solid Organ Transplantation, University of Nebraska Medical Center, Omaha 68198-3285, USA.
Leone
J P
JP
Fidler
M E
ME
Hammeke
M D
MD
Tarantolo
S
S
D000328:Adult; D000077144:Clopidogrel; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology; D016572:Cyclosporine / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010956:Plasmapheresis; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced* / Q000628:therapy; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives*
D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D016572:Cyclosporine; D000077144:Clopidogrel; D013988:Ticlopidine