Tacrolimus-associated hemolytic uremic syndrome: a case analysis.
BACKGROUND
Tacrolimus is an effective organ transplantation immunosuppressant. Hemolytic uremic syndrome (HUS) is a rare but severe complication of tacrolimus.


METHODS
We report a case of tacrolimus-associated HUS and review the 15 previously reported cases.


RESULTS
The results of the 16 cases indicated that tacrolimus-associated HUS is more frequent in females (56.3%), with the mean age at onset of 41.3 years. Forty-four percent of cases received renal transplantations. The average time from the first tacrolimus dose to HUS onset was 7.1 months. Prevalence was between 0.14.7%. The tacrolimus trough level did not predict the prognosis. Seven patients (43.7%) had improved graft function after treatment, including anticoagulation and antiplatelet therapy, reduction or discontinuation of tacrolimus, switch to cyclosporine (CyA), plasma exchange (PE) and dialysis. Five patients (31.3%) died and four patients (25%) lost their graft in spite of the above treatment. Mortality risk factors for transplant recipients with tacrolimus-associated HUS included: (1) non-renal transplant recipients (100% vs. 36.4%, p = 0.034); (2) lower peak serum Cr (2.58 +/- 1.23 vs. 6.16 +/- 1.96, p < 0.002); (3) liver dysfunction (60% vs. 0, p < 0.02); (4) higher serum lactate dehydrogenase (LDH) level (3119 +/- 1019 vs. 982 +/- 522, p < 0.001). A lower platelet count carried borderline mortality risk (29500 +/- 14480 vs. 59625 +/- 25584, p = 0.057).


CONCLUSIONS
HUS should be included in the differential diagnosis of renal function deterioration in patients on tacrolimus post-organ transplantation. Frequent renal function monitoring and appropriate treatment should be performed aggressively to decrease morbidity and mortality, especially in patients with risk factors.
Lin
Chih-Ching
CC
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China. lincc2@vghtpe.gov.tw
King
Kuang-Liang
KL
Chao
Yu-Wen
YW
Yang
An Han
AH
Chang
Chao-Fu
CF
Yang
Wu-Chang
WC
D000328:Adult; D001707:Biopsy, Needle; D005500:Follow-Up Studies; D006084:Graft Rejection; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods; D011183:Postoperative Complications / Q000188:drug therapy; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000188:drug therapy*; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
D016559:Tacrolimus