title: Thrombotic microangiopathy associated with combined sirolimus and tacrolimus immunosuppression after intestinal transplantation.
abstract: Calcineurin inhibitor-induced thrombotic microangiopathy (TMA) has been described in up to 14% of solid-organ transplant recipients. Sirolimus has recently been described in two reports in association with TMA. Sirolimus is known to potentiate cyclosporine-induced nephrotoxicity, but such effect has not been shown with tacrolimus. We report two intestinal transplant patients who developed TMA while on a tacrolimus and sirolimus immunosuppressive regimen. This syndrome appeared soon after institution of or increase in sirolimus dosage and improved only after this medication was discontinued.
authors.affiliation: The Recanati/Miller Transplantation Institute, Division of Intestinal Transplantation, The Mount Sinai School of Medicine, New York, New York, USA.
authors.forename: Anil S
authors.initials: AS
authors.lastname: Paramesh
authors.forename: Celia
authors.initials: C
authors.lastname: Grosskreutz
authors.forename: Sander S
authors.initials: SS
authors.lastname: Florman
authors.forename: Gabriel E
authors.initials: GE
authors.lastname: Gondolesi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.forename: Stuart S
authors.initials: SS
authors.lastname: Kaufman
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Fishbein
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008833:Microcirculation; D020123:Sirolimus / Q000009:adverse effects*; D016559:Tacrolimus / Q000009:adverse effects*; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus